P2.P306: Socio-Economic and Financial Impact of Jejunal Tube Feeding in Children: A Cohort Study at a Tertiary Care Institute

Background: Jejunal tube feeding (JTF) is essential for enteral nutrition in children with neurodisabilities and gut dysmotility. It necessitates frequent tube changes every six months and regular hospital visits, significantly disrupting family life as parents often need time off work. This study explores the socio-economic impact of JTF on families and the financial burden on healthcare systems.

Methods: This was a retrospective cohort study at a tertiary pediatric institute including all patients with JTF, from 2011-2023. Data collected from electronic patient records included type of JTF procedures (primary or secondary), anesthesia used and complications. Costs associated with hospital admissions, tube changes, and patient travel expenses were computed using the lower national tariff brackets and travel metrics from Google Maps® and the GOV.UK advisory fuel rate. Statistical analyses were performed using R 4.4.0.

Results: This study included 58 patients, with 19 undergoing primary and 40 undergoing secondary JTF procedures. Patients required a median of two tube changes per year. Emergency procedures accounted for 42.3% (141 out of 333 procedures) and often required overnight hospital stays, which occurred in 55.0% (183 out of 333) of cases. The median annual hospital cost per patient reached £12,246, cumulatively amounting to a minimum annual expenditure of £860,086 on tube changes alone. Additionally, patients incurred a median travel cost of £50.15 per year.

The highest frequency of general anesthesia used for a single patient within this cohort was 19 times, with a median of 5 times across all patients. Intervention radiologists primarily conducted the tube changes. Neurological symptoms were the most common indications for JTF, with cerebral palsy being the prevalent condition in 44.8% (26 out of 58) of the patients. Gastroesophageal reflux disease (GORD) emerged as the primary comorbidity, affecting 46 patients. Frequent tube complications included displacement (45%), blockage (15%), and damage (13%), the majority of which occurring in tubes not replaced within the recommended six-month period. Moreover, 8.6% of patients experienced severe complications such as gastric ulceration, jejunal perforation, and buried bumpers.

Conclusion: Jejunal tube feeding significantly impacts both the economic and physical well-being of patients and healthcare systems, with a high rate of emergency interventions exacerbating these costs. Delaying tube changes not only imposes higher costs due to emergency procedures but also disrupts scheduled hospital services and places additional unexpected burdens on patients. Strict adherence to scheduled tube changes, and the availability of local hospitals to provide care services and support with tube maintenance can mitigate these burdens. Furthermore, it is vital to consider the often-overlooked significant health risks of repeated general anesthesia and to emphasize the need for thorough patient counseling on tube maintenance. Given the challenges of repeated hospital admissions, opting for a surgical jejunostomy may be prudent, despite its association with serious complications.