P2.Q321: Identifying Quality Improvement Targets after Pediatric Gastrostomy Tube Insertion: A National NSQIP-Pediatric Pilot

Background: Gastrostomy tube (GT) placement is one of the most common and morbid procedures performed by pediatric surgeons, but there is currently no national clinical data registry that provides participants with feedback on GT-specific care processes and morbidity. The American College of Surgeons (ACS) National Surgical Quality Improvement Program - Pediatric (NSQIP-Ped) GT Pilot was created to fill this gap. This study analyzes the first available pilot data regarding GT-specific morbidity burden and variability in preoperative imaging and concurrent anti-reflux procedure performance among NSQIP-Ped children’s hospitals.

Methods: This study was a retrospective cohort analysis of children (less than 18 years old) who underwent GT placement at one of 71 NSQIP-Ped sites participating in GT pilot variable collection from January to December 2023. Analysis was limited to GTs placed in children who had not previously had a GT. GT-specific morbidity collected included 0-60 day GT dislodgements and 0-30 day readmissions, emergency department (ED) visits, and interventional radiology (IR) interventions. These four outcome measures were combined into a composite GT-specific morbidity variable. Additional data collection included proportion of GTs with preoperative upper gastrointestinal (UGI) studies and concurrent fundoplication. Interhospital variability was captured by comparing median hospital-based proportions and interquartile ranges (IQR).

Results: GTs represented 5.3% (8047/151508) of operations submitted to NSQIP-Ped from all 157 sites in 2023. The 71 pilot sites submitted 57% (4612/8047) of GT cases, with 77% (3563/4612) of these cases being first-time GT. GT-specific morbidity was common: 12% (434/3563) ED visits, 8.9% (317/3563) 0-60 day dislodgements, 3.0% (104/3563) readmissions, 1.0% (36/3563) IR interventions, and 17% (623/3563) composite GT-specific morbidity events (Figure 1). Widest interhospital variability was found in proportion of GTs with preoperative UGI studies, with a median hospital-based proportion of 46% (IQR: 31, 69) (Figure 2). Proportion of GTs with concurrent fundoplication varied less, with a median hospital-based proportion of 0 (IQR: 0, 4.2).

Conclusion: This multicenter, national pilot study revealed that the most common GT-specific post-operative morbidities were ED visits and dislodgements, and highest variability in preoperative UGI use. The high interhospital variability suggests these variables may be viable improvement targets. These data highlight the areas of GT-specific morbidity causing the most patient harm and perioperative processes with the most opportunity for standardization across the pediatric surgical community. As the NSQIP-Ped GT pilot evolves, our collective efforts can lead to the development of more refined guidelines and protocols to enhance the safety and efficacy of GT placement in pediatric patients.