Infant gastrostomy outcomes: The cost of complications.
OBJECTIVE
Comparative outcomes of enhanced percutaneous endoscopic gastrostomy (PEG) and laparoscopic gastrostomy (LG) have not been elucidated in infants. We describe the outcomes and procedural episodic expenditures of PEG versus LG in this high-risk population.


METHODS
One hundred eighty-three gastrostomies in children under 1year were reviewed from our institution spanning 1/2011-6/2015. Pertinent demographics and 3-month complications (mortality, gastrocolic fistula, reoperation, cellulitis, granulation, pneumonia, and tube dislodgement <6weeks) were collected. Facility and professional administrative data was used to conduct a charge and cost analysis of PEG and LG procedures as well as their statistically significant complications.


RESULTS
Seventy-eight PEG and 105 LG infants were compared. LG infants were significantly younger, had higher ASA class, and increased frequency of cardiopulmonary disease. Significant major complications included a 3.8% incidence of gastrocolic fistula among PEGs (3.8% vs 0%, p=0.04) and 7.6% early tube dislodgements among LG infants (0 vs. 7.6%, p=0.01), resulting in $86,896 of additional charges with PEG complication. Incorporating complication frequency, average charges and variable cost per case were $8964 and $253 greater using PEG.


CONCLUSIONS
Despite a healthier cohort, infants undergoing enhanced PEG have more morbid and costly complications. LG may be the less burdensome approach to gastrostomy in infants.


METHODS
Case-Control Study/Retrospective Comparative Study - Level III.
Children's Research Institute and Children's Hospital of Wisconsin, Milwaukee, WI 53226; Medical College of Wisconsin, Milwaukee, WI 53226. Electronic address: rlandisch@chw.org.
Rachel M
RM
Landisch
Children's Research Institute and Children's Hospital of Wisconsin, Milwaukee, WI 53226.
Ryan C
RC
Colwell
Children's Research Institute and Children's Hospital of Wisconsin, Milwaukee, WI 53226; Medical College of Wisconsin, Milwaukee, WI 53226.
John C
JC
Densmore
D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000191:economics*; D005774:Gastrostomy / Q000191:economics / Q000379:methods*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000191:economics*; D008297:Male; D011183:Postoperative Complications / Q000191:economics* / Q000453:epidemiology; D012086:Reoperation / Q000191:economics; D012189:Retrospective Studies; D014922:Wisconsin
Cost; Gastrostomy; Infant; Laparoscopic; Outcome; PEG