Y.I. Gely1, M. Mahmoud2, J. Zagory1,3 1Louisiana State University Health Sciences Center, Department Of Surgery, New Orleans, LA, USA 2Tulane University School Of Medicine, Department Of Surgery, New Orleans, LA, USA 3Children’s Hospital of New Orleans, Department Of Pediatric Surgery, New Orleans, LA, USA
Introduction: Gastrostomy tube (GT) placement is a common surgery to supplement nutritional requirements for children with feeding difficulties. Previous studies have shown that patients with Trisomy 21 (T21) have increased postoperative complications related to wound healing. We aim to determine if operative complications related to wound healing are increased in patients with T21 undergoing GT placement compared to their non-T21 counterparts.
Methods: We performed a retrospective study using the deidentified National Surgical Quality Improvement Program—Pediatrics database from 2012 to 2020. Children under 18 years of age with GT placement, identified by Current Procedural Terminology (CPT) codes, were included and stratified based on the international classification of disease (ICD) T21 diagnosis. Demographics, case characteristics, and postoperative complications were analyzed. The primary outcome was postoperative complications after GT placement related to wound healing. Chi-square, Wilcoxon Mann-Whitney, and multivariate logistic regression were used for statistical analysis.
Results: Of 31,244 patients with GT procedures, 1,495 (4.8%) had T21. Laparoscopic GT placement was the most common procedure overall (76.8%), followed by open gastrostomy (16.5%). When compared to their non-T21 counterparts, T21 patients were more likely to be younger at the time of surgery (112 vs 238 days, p<0.001), white, non-Hispanic (p<0.001), lower weight at the time of surgery (10.7 vs 14.7 kg, p<0.001), older gestational age at birth (37.0 vs 36.0 weeks, p<0.001), had previous cardiac surgery (37.5% vs 15.0%, p<0.001), have major and minor cardiac risk factors (major: 59.9% vs 21.3%, minor: 24.7% vs 18.3%, p<0.001), have structural pulmonary/airway anomalies (25.6% vs 19.2%, p<0.001), and esophageal/gastric/intestinal disease (54.3% vs 51.4%, p=0.029). T21 patients were also more likely to be treated inpatient (89.4% vs 86.2%, p<0.001), require oxygen support (24.9% vs 18.7%, p<0.001), undergo elective cases (93% vs 92%, p=0.026), and have higher ASA class (p<0.001). In our adjusted analysis, T21 patients were more likely to have postoperative complications related to wound healing (OR 1.23 [1-1.5] p=0.046).
Conclusion: Significant differences exist between T21 patients and their non-T21 counterparts who undergo GT placement procedures, particularly in postoperative complications related to wound healing. Further investigation into the unique wound healing differences in T21 patients is warranted.