Trends in gastrostomy tube placement with concomitant Nissen fundoplication for infants and young children at Pediatric Tertiary Centers

Megan E. Bouchard*, Danielle Howard Stewart, Matt Hall, Benjamin T. Many, Jonathan C. Vacek, Steven Papastefan, Kyle Van Arendonk, Fizan Abdullah, Seth D. Goldstein

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Purpose: In infants and toddlers, gastrostomy tube placement (GT) is typically accompanied by consideration of concomitant Nissen fundoplication (NF). Historically, rates of NF have varied across providers and institutions. This study examines practice variation and longitudinal trends in NF at pediatric tertiary centers. Methods: Patients ≤ 2 years who underwent GT between 2008 and 2018 were identified in the Pediatric Health Information System database. Patient demographics and rates of NF were examined. Descriptive statistics were used to evaluate the variation in the proportion of GT with NF at each hospital, by volume and over time. Results: 40,348 patients were identified across 40 hospitals. Most patients were male (53.8%), non-Hispanic white (49.5%) and publicly-insured (60.4%). Rates of NF by hospital varied significantly from 4.2 to 75.2% (p < 0.001), though were not associated with geographic region (p = 0.088). Rates of NF decreased from 42.8% in 2008 to 14.2% in 2018, with a mean annual rate of change of − 3.07% (95% CI − 3.53, − 2.61). This trend remained when stratifying hospitals into volume quartiles. Conclusion: There is significant practice variation in performing NF. Regardless of volume, the rate of NF is also decreasing. Objective NF outcome measurements are needed to standardize the management of long-term enteral access in this population.

Original languageEnglish (US)
Pages (from-to)617-625
Number of pages9
JournalPediatric Surgery International
Volume37
Issue number5
DOIs
StatePublished - May 2021

Keywords

  • Gastrostomy tube
  • Infants and young children
  • Nissen fundoplication
  • Practice variation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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