Pediatric multicenter cohort comparison of percutaneous endoscopic and non-endoscopic gastrostomy technique outcomes
Enteral access is one of the mainstays of nutritional support. Several different modalities for gastrostomy placement are established. In pediatrics, however, there is a limited evidence base supporting the choice of 1 modality over the others. We retrospectively compared elective percutaneous endos...
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| Veröffentlicht in: | Journal of investigative medicine 2020-02, Vol.68 (2), p.413-418 |
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| creator | Kumar, Ashwath S Bani Yaghoub, Majid Rekab, Kamel Hall, Matt Attard, Thomas Mario |
| description | Enteral access is one of the mainstays of nutritional support. Several different modalities for gastrostomy placement are established. In pediatrics, however, there is a limited evidence base supporting the choice of 1 modality over the others. We retrospectively compared elective percutaneous endoscopically placed gastrostomy (PEG) with surgical and interventional radiology-placed gastrostomy outcomes using the Pediatric Hospital Inpatient Sample multicenter administrative database (Pediatric Health Information System). Pediatric patients ( |
| doi_str_mv | 10.1136/jim-2019-001028 |
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Several different modalities for gastrostomy placement are established. In pediatrics, however, there is a limited evidence base supporting the choice of 1 modality over the others. We retrospectively compared elective percutaneous endoscopically placed gastrostomy (PEG) with surgical and interventional radiology-placed gastrostomy outcomes using the Pediatric Hospital Inpatient Sample multicenter administrative database (Pediatric Health Information System). Pediatric patients (<18 years) undergoing planned elective gastrostomy (2010–2015) were included. Coded gastrostomy procedure subtype, patient demographic characteristics, chronic comorbidities and subsequent related outcomes, mortality, readmission, length of stay and total cost of admission were analyzed. Univariate analysis differentiated among gastrostomy techniques. The effect of gastrostomy on mortality and 30-day readmission were determined using a forward, stepwise, binary logistic regression. Generalized linear models were used to estimate the effect of gastrostomy type on length of stay and total cost. During the study period, 11,712 children underwent gastrostomy, including PEG (27%). Patients with chronic comorbidities were more, or as likely to undergo non-PEG procedures. Postoperatively, PEG patients were less likely to require mechanical ventilation and total parenteral nutrition (TPN). Gastrostomy type was not predictive of mortality; predictors included non-White race and need for mechanically assisted ventilation. Readmission following gastrostomy was common (29.5%), and more likely in PEG patients (OR 1.31). Predictors of readmission included earlier TPN (OR 1.39), cardiovascular (OR 1.17) and oncology (OR 4.17) comorbidities. Our study suggests that PEG placement entails similar length of stay and cost as in non-PEG gastrostomy. Patients undergoing PEG were less likely to require mechanical ventilation and TPN postoperatively. Mortality is similar in both groups although more likely with specific comorbidities. Racial background appeared to be associated with choice of gastrostomy, length of stay and mortality.</description><identifier>ISSN: 1081-5589</identifier><identifier>EISSN: 1708-8267</identifier><identifier>DOI: 10.1136/jim-2019-001028</identifier><identifier>PMID: 31562228</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Age ; Congenital diseases ; Disease ; Emergency medical care ; Endoscopy ; Generalized linear models ; Hispanic people ; Hospitalization ; Laparoscopy ; Metabolism ; Mortality ; Nutrition ; Ostomy ; Parenteral nutrition ; Patient satisfaction ; Pediatrics ; Variables ; Ventilators</subject><ispartof>Journal of investigative medicine, 2020-02, Vol.68 (2), p.413-418</ispartof><rights>American Federation for Medical Research 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2020 American Federation for Medical Research</rights><rights>2020 American Federation for Medical Research 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b397t-2c297b525f81848a1c49f3ad97c557706c0726c52e83c5952090a5fa7d1872033</citedby><cites>FETCH-LOGICAL-b397t-2c297b525f81848a1c49f3ad97c557706c0726c52e83c5952090a5fa7d1872033</cites><orcidid>0000-0002-7480-4437</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1136/jim-2019-001028$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1136/jim-2019-001028$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,777,781,21800,27905,27906,43602,43603</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31562228$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kumar, Ashwath S</creatorcontrib><creatorcontrib>Bani Yaghoub, Majid</creatorcontrib><creatorcontrib>Rekab, Kamel</creatorcontrib><creatorcontrib>Hall, Matt</creatorcontrib><creatorcontrib>Attard, Thomas Mario</creatorcontrib><title>Pediatric multicenter cohort comparison of percutaneous endoscopic and non-endoscopic gastrostomy technique outcomes</title><title>Journal of investigative medicine</title><addtitle>J Investig Med</addtitle><description>Enteral access is one of the mainstays of nutritional support. Several different modalities for gastrostomy placement are established. In pediatrics, however, there is a limited evidence base supporting the choice of 1 modality over the others. We retrospectively compared elective percutaneous endoscopically placed gastrostomy (PEG) with surgical and interventional radiology-placed gastrostomy outcomes using the Pediatric Hospital Inpatient Sample multicenter administrative database (Pediatric Health Information System). Pediatric patients (<18 years) undergoing planned elective gastrostomy (2010–2015) were included. Coded gastrostomy procedure subtype, patient demographic characteristics, chronic comorbidities and subsequent related outcomes, mortality, readmission, length of stay and total cost of admission were analyzed. Univariate analysis differentiated among gastrostomy techniques. The effect of gastrostomy on mortality and 30-day readmission were determined using a forward, stepwise, binary logistic regression. Generalized linear models were used to estimate the effect of gastrostomy type on length of stay and total cost. During the study period, 11,712 children underwent gastrostomy, including PEG (27%). Patients with chronic comorbidities were more, or as likely to undergo non-PEG procedures. Postoperatively, PEG patients were less likely to require mechanical ventilation and total parenteral nutrition (TPN). Gastrostomy type was not predictive of mortality; predictors included non-White race and need for mechanically assisted ventilation. Readmission following gastrostomy was common (29.5%), and more likely in PEG patients (OR 1.31). Predictors of readmission included earlier TPN (OR 1.39), cardiovascular (OR 1.17) and oncology (OR 4.17) comorbidities. Our study suggests that PEG placement entails similar length of stay and cost as in non-PEG gastrostomy. Patients undergoing PEG were less likely to require mechanical ventilation and TPN postoperatively. Mortality is similar in both groups although more likely with specific comorbidities. Racial background appeared to be associated with choice of gastrostomy, length of stay and mortality.</description><subject>Age</subject><subject>Congenital diseases</subject><subject>Disease</subject><subject>Emergency medical care</subject><subject>Endoscopy</subject><subject>Generalized linear models</subject><subject>Hispanic people</subject><subject>Hospitalization</subject><subject>Laparoscopy</subject><subject>Metabolism</subject><subject>Mortality</subject><subject>Nutrition</subject><subject>Ostomy</subject><subject>Parenteral nutrition</subject><subject>Patient satisfaction</subject><subject>Pediatrics</subject><subject>Variables</subject><subject>Ventilators</subject><issn>1081-5589</issn><issn>1708-8267</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkctLAzEQxoMovs_eZMGLiGuT2WaTHKX4goIe9BzSbLbd0k3WJHvof2_K1geCeJph-M33ZfIhdEbwDSFFOVo2bQ6YiBxjgoHvoEPCMM85lGw39ZiTnFIuDtBRCEuMoaQC9tFBQWgJAPwQxRdTNSr6Rmdtv4qNNjYan2m3cD6m0nbKN8HZzNVZZ7zuo7LG9SEztnJBuy4tKltl1tn8x2iuQvQuRNeus2j0wjbvvclcH5OiCSdor1arYE639Ri93d-9Th7z6fPD0-R2ms8KwWIOGgSbUaA1J3zMFdFjUReqEkxTyhguNWZQagqGF5oKClhgRWvFKsIZ4KI4RpeDbudd8g9Rtk3QZrUabpAAQpAxYYQl9OIXunS9t-l1EooxB0jfuqFGA6XTccGbWna-aZVfS4LlJhCZApGbQOQQSNo43-r2s9ZUX_xnAgm4HoCg5ubb9G-9qwGftct_zT8AbaOifg</recordid><startdate>202002</startdate><enddate>202002</enddate><creator>Kumar, Ashwath S</creator><creator>Bani Yaghoub, Majid</creator><creator>Rekab, Kamel</creator><creator>Hall, Matt</creator><creator>Attard, Thomas Mario</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AM</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BGRYB</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K7.</scope><scope>K9.</scope><scope>M0O</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7480-4437</orcidid></search><sort><creationdate>202002</creationdate><title>Pediatric multicenter cohort comparison of percutaneous endoscopic and non-endoscopic gastrostomy technique outcomes</title><author>Kumar, Ashwath S ; Bani Yaghoub, Majid ; Rekab, Kamel ; Hall, Matt ; Attard, Thomas Mario</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b397t-2c297b525f81848a1c49f3ad97c557706c0726c52e83c5952090a5fa7d1872033</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Age</topic><topic>Congenital diseases</topic><topic>Disease</topic><topic>Emergency medical care</topic><topic>Endoscopy</topic><topic>Generalized linear models</topic><topic>Hispanic people</topic><topic>Hospitalization</topic><topic>Laparoscopy</topic><topic>Metabolism</topic><topic>Mortality</topic><topic>Nutrition</topic><topic>Ostomy</topic><topic>Parenteral nutrition</topic><topic>Patient satisfaction</topic><topic>Pediatrics</topic><topic>Variables</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kumar, Ashwath S</creatorcontrib><creatorcontrib>Bani Yaghoub, Majid</creatorcontrib><creatorcontrib>Rekab, Kamel</creatorcontrib><creatorcontrib>Hall, Matt</creatorcontrib><creatorcontrib>Attard, Thomas Mario</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Criminal Justice Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Social Science Premium Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Criminology Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Criminal Justice (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Criminal Justice</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of investigative medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kumar, Ashwath S</au><au>Bani Yaghoub, Majid</au><au>Rekab, Kamel</au><au>Hall, Matt</au><au>Attard, Thomas Mario</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pediatric multicenter cohort comparison of percutaneous endoscopic and non-endoscopic gastrostomy technique outcomes</atitle><jtitle>Journal of investigative medicine</jtitle><addtitle>J Investig Med</addtitle><date>2020-02</date><risdate>2020</risdate><volume>68</volume><issue>2</issue><spage>413</spage><epage>418</epage><pages>413-418</pages><issn>1081-5589</issn><eissn>1708-8267</eissn><abstract>Enteral access is one of the mainstays of nutritional support. Several different modalities for gastrostomy placement are established. In pediatrics, however, there is a limited evidence base supporting the choice of 1 modality over the others. We retrospectively compared elective percutaneous endoscopically placed gastrostomy (PEG) with surgical and interventional radiology-placed gastrostomy outcomes using the Pediatric Hospital Inpatient Sample multicenter administrative database (Pediatric Health Information System). Pediatric patients (<18 years) undergoing planned elective gastrostomy (2010–2015) were included. Coded gastrostomy procedure subtype, patient demographic characteristics, chronic comorbidities and subsequent related outcomes, mortality, readmission, length of stay and total cost of admission were analyzed. Univariate analysis differentiated among gastrostomy techniques. The effect of gastrostomy on mortality and 30-day readmission were determined using a forward, stepwise, binary logistic regression. Generalized linear models were used to estimate the effect of gastrostomy type on length of stay and total cost. During the study period, 11,712 children underwent gastrostomy, including PEG (27%). Patients with chronic comorbidities were more, or as likely to undergo non-PEG procedures. Postoperatively, PEG patients were less likely to require mechanical ventilation and total parenteral nutrition (TPN). Gastrostomy type was not predictive of mortality; predictors included non-White race and need for mechanically assisted ventilation. Readmission following gastrostomy was common (29.5%), and more likely in PEG patients (OR 1.31). Predictors of readmission included earlier TPN (OR 1.39), cardiovascular (OR 1.17) and oncology (OR 4.17) comorbidities. Our study suggests that PEG placement entails similar length of stay and cost as in non-PEG gastrostomy. Patients undergoing PEG were less likely to require mechanical ventilation and TPN postoperatively. Mortality is similar in both groups although more likely with specific comorbidities. Racial background appeared to be associated with choice of gastrostomy, length of stay and mortality.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>31562228</pmid><doi>10.1136/jim-2019-001028</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-7480-4437</orcidid></addata></record> |
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| ispartof | Journal of investigative medicine, 2020-02, Vol.68 (2), p.413-418 |
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| language | eng |
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| source | SAGE Complete A-Z List |
| subjects | Age Congenital diseases Disease Emergency medical care Endoscopy Generalized linear models Hispanic people Hospitalization Laparoscopy Metabolism Mortality Nutrition Ostomy Parenteral nutrition Patient satisfaction Pediatrics Variables Ventilators |
| title | Pediatric multicenter cohort comparison of percutaneous endoscopic and non-endoscopic gastrostomy technique outcomes |
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