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

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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.

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Funding

The authors have no financial relationships relevant to this article to disclose. No funding was secured for this study.

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Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611, USA

    Megan E. Bouchard, Danielle Howard Stewart, Benjamin T. Many, Jonathan C. Vacek, Steven Papastefan, Fizan Abdullah & Seth D. Goldstein

  2. Children’s Hospital Association, Lenexa, KS, USA

    Matt Hall

  3. Division of Pediatric Surgery, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee, WI, USA

    Kyle Van Arendonk

Authors
  1. Megan E. Bouchard
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  2. Danielle Howard Stewart
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  3. Matt Hall
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  9. Seth D. Goldstein
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Correspondence to Megan E. Bouchard.

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Bouchard, M.E., Stewart, D.H., Hall, M. et al. Trends in gastrostomy tube placement with concomitant Nissen fundoplication for infants and young children at Pediatric Tertiary Centers. Pediatr Surg Int 37, 617–625 (2021). https://doi.org/10.1007/s00383-020-04845-3

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  • DOI: https://doi.org/10.1007/s00383-020-04845-3

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