title: Estimating Adverse Events After Gastrostomy Tube Placement.
abstract: OBJECTIVE
  Gastrostomy feeding tube placement in children is associated with a high frequency of adverse events. This study sought to preoperatively estimate postoperative adverse events in children undergoing gastrostomy feeding tube placement.
  
  
  METHODS
  This was an observational study of children who underwent gastrostomy with or without fundoplication at 1 of 50 participating hospitals, using 2011-2013 data from the American College of Surgeons' National Surgical Quality Improvement Program Pediatric. The outcome was the occurrence of any postoperative complications or mortality at 30 days after gastrostomy tube placement. The preoperative clinical characteristics significantly associated with occurrence of adverse events were included in a multivariate logistic model. The area under the receiver operating characteristic curve was computed to assess model performance and split-set validated.
  
  
  RESULTS
  A total of 2817 children were identified as having undergone gastrostomy tube placement. The unadjusted rate of adverse events within 30 days after gastrostomy tube placement was 11%. Thirteen predictor variables were identified. Notable preoperative variables associated with a greater than 75% increase in adverse event rate were preoperative sepsis/septic shock (odds ratio [OR], 10.76, 95% confidence interval [CI], 3.84-30.17), central nervous system tumor (OR, 3.36; 95% CI, 1.42-7.95), the primary procedure as indicated by the current procedural terminology (CPT) linear risk variable (OR, 1.93; 95% CI, 1.50-2.49), severe cardiac risk factors (OR, 1.88; 95% CI, 1.17-3.03), and preoperative seizure history (OR, 1.90; 95% CI, 1.38-2.62). The area under the receiver operating characteristic curve was 0.71 with the derivation data set and 0.71 upon split-set validation.
  
  
  CONCLUSIONS
  Preoperatively estimating postoperative adverse events in children undergoing gastrostomy tube placement is feasible.
authors: Icahn School of Medicine at Mount Sinai Medical Center, New York, NY; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif. Electronic address: as013j@gmail.com.
authors: Anne M
authors: AM
authors: Stey
authors: Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
authors: Brian D
authors: BD
authors: Kenney
authors: American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, Ill.
authors: Mark E
authors: ME
authors: Cohen
authors: Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
authors: R Lawrence
authors: RL
authors: Moss
authors: American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, Ill; Washington University School of Medicine in Saint Louis, Department of Surgery, Olin Business School, and Center for Health Policy, St Louis VA Medical Center; BJC Healthcare, Saint Louis, Mo.
authors: Bruce L
authors: BL
authors: Hall
authors: Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical College, Wilmington, Del.
authors: Loren
authors: L
authors: Berman
authors: American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, Ill.
authors: Kari
authors: K
authors: Kraemer
authors: David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif; American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, Ill.
authors: Clifford Y
authors: CY
authors: Ko
authors: Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical College, Wilmington, Del.
authors: Charles D
authors: CD
authors: Vinocur
mesh_terms: D000293:Adolescent; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D016543:Central Nervous System Neoplasms / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication; D005774:Gastrostomy / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology*; D018805:Sepsis / Q000453:epidemiology; D012772:Shock, Septic / Q000453:epidemiology*
keywords: ACS-NSQIP-Pediatric; children with special health care needs; gastrostomy enteral access; risk calculator