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.

Type of study: Multi-institutional, retrospective, cohort study.