婴儿和儿童使用胃空肠造口术管道的并发症发生率和变异性。

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2024-10-29 DOI:10.1016/j.jpedsurg.2024.162047

Oliver S. Zhao , Maren E. Shipe , Melissa E. Danko , Eunice Y. Huang , Jamie R. Robinson

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引用次数: 0

摘要

背景：胃空肠造口管（GJT）置入术通常用于胃喂养不耐受儿童的肠道通路和幽门后喂养。先前的研究表明，与年长儿童相比，婴儿发生手术并发症的风险更高。我们的目的是通过两个国家数据库了解儿童使用 GJT 的特点，并调查术后并发症的风险因素：我们利用两个国家数据库，即美国儿科外科学院国家外科质量改进计划（Ped-NSQIP）和儿科健康信息系统（PHIS），对接受 GJT 置入术的儿童进行了一项多机构回顾性队列研究。在每个队列中分别进行了分析，以确定婴儿之间的结果差异（结果：在Ped-NSQIP队列（26.9% vs. 29.0%，p = 0.84）或PHIS队列（35.3% vs. 30.7%，p = 0.07）中，婴儿的手术并发症发生率与非婴儿相比没有增加。非裔美国人婴儿（OR 1.93，95 % CI 1.01-3.67）和非婴儿（OR 1.64，95 % CI 1.27-2.10）发生并发症的风险增加，婴儿和非婴儿发生紧急手术或急诊手术的风险也增加（OR 分别为 5.42-6.46 和 OR 2.12-2.61）。不同机构的GJT置入率和并发症发生率存在显著差异：我们发现婴儿和非婴儿的 GJT 置入并发症发生率相当高，但总体情况相似。这些研究结果表明，在儿童肠道通路时，不应仅凭年龄而否定 GJT 的置入：3：研究类型：多机构、回顾性、队列研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Complication Rates and Variability in Gastrojejunostomy Tube Usage in Infants and Children

Background

Gastrojejunostomy tube (GJT) placement is commonly performed for enteral access and post-pyloric feeding in children with gastric feeding intolerance. Prior studies have suggested the risk of surgical complications is elevated in infants compared to older children. We aim to characterize GJT usage in children and investigate the risk factors for postoperative complications through two national databases.

Methods

We performed a multi-institutional retrospective cohort study on children who underwent GJT placement utilizing two national databases, the Pediatric American College of Surgeons National Surgical Quality Improvement Program (Ped-NSQIP) and the Pediatric Health Information System (PHIS). Analyses were performed within each cohort separately to determine differences in outcomes between infants (<1 year of age) and non-infants (≥1 year of age). Multivariable logistic regression was performed to determine associations with postoperative complications.

Results

Infants did not have an increased rate of surgical complications compared to non-infants in the Ped-NSQIP cohort (26.9 % vs. 29.0 %, p = 0.84) or PHIS cohort (35.3 % vs. 30.7 %, p = 0.07). There was an increased risk of complications in African American infants (OR 1.93, 95 % CI 1.01–3.67) and non-infants (OR 1.64, 95 % CI 1.27–2.10) and for urgent procedures or emergent procedures in both infants and non-infants (OR 5.42–6.46 and OR 2.12–2.61, respectively). GJT placement and complication rates significantly varied across institutions.

Conclusion

We demonstrate substantial but similar overall complication rates of GJT placement between infants and non-infants. These findings suggest age alone should not negate placement of GJTs when indicated for enteral access in children.

Level of Evidence

Type of study

Multi-institutional, retrospective, cohort study.

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.