A. Goldin2, K. Heiss3, M. Hall4, D. Rothstein5, P. Minneci6, M. Blakely7, S. Shah9, S. Rangel10, L. Berman12, C. Snyder11, C. Vinocur12, M. Browne8, M. Raval3, M. Arca13 2Seattle Children’s Hospital,Seattle, WA, USA 3Emory University School Of Medicine,Atlanta, GA, USA 4Children’s Hospital Association,Overland Park, KANSAS, USA 5Women And Children’s Hospital Of Buffalo,Buffalo, NEW YORK, USA 6Nationwide Children’s Hospital,Columbus, OH, USA 7Vanderbilt University Medical Center,Nashville, TN, USA 8Lurie Children’s Hospital,Chicago, ILLINOIS, USA 9Cincinnati Children’s Hospital Medical Center,Cincinnati, OH, USA 10Children’s Hospital Boston,Boston, MA, USA 11Children’s Mercy Hospital- University Of Missouri Kansas City,Kansas City, MO, USA 12Nemours Alfred DuPont Hospital For Chldren,Wilmington, DE, USA 13Children’s Hospital Of Wisconsin,Milwaukee, WI, USA
Introduction:
Gastrostomy tubes (GT) are devices placed to supplement hydration, nutrition, and medication administration in infants and children. Anecdotally, children with these GT’s utilize health resources frequently. We wanted to quantify the post-operative needs of this population by identifying the incidence of 30-day post-discharge emergency department (ED) visits and hospital readmissions following GT placement. We wanted to identify the GT-related reasons for visits and readmissions.
Methods:
This multicenter retrospective cohort study used data from the Pediatric Health Information System. Patients <18 years of age who were discharged between January 1, 2010 and December 31, 2012, with an ICD-9-CM procedure code for GT placement during the index hospitalization were included. Subjects were classified as having the GT placed on the date of admission (scheduled gastrostomy cohort) or later in the hospital course (unscheduled gastrostomy cohort). Factors significantly associated with ED revisits and hospital readmissions within 30-days of hospital discharge were identified using multivariable logistic regression. IRB-approved validation studies were conducted in five institutions on a randomly generated subset of patients to confirm the accuracy of exposures and outcomes.
Results:
During the study period, 15,642 patients had a GT placed; 67% were ≤ one year old, 25% had the GT placed on the day of admission, and 72% had ≥1 chronic comorbid condition (CCC). Overall, 8.6% of all patients had an ED visit within 30 days of hospital discharge, and 3.9% of all patients were readmitted through the ED with GT-related issues. GT-related events associated with these visits included infection (27%), mechanical complication (22%), and replacement (19%). In multivariable analysis, timing of GT placement (scheduled vs. unscheduled) was not associated with either ED revisits or hospital readmission. Hispanic ethnicity, non-Hispanic black race, and the presence of three or more CCCs were independently associated with ED revisits, while gastroesophageal reflux and not having a concomitant fundoplication at time of GT placement were independently associated with hospital readmission.
Conclusion:
GT placement is associated with high rates of ED revisits and hospital readmissions in the first 30 days after hospital discharge. The association of non-modifiable risk factors such as race/ethnicity and medical complexity is an initial step towards understanding this population so that interventions can be developed to decrease these potentially preventable occurrences.