Identifying Quality Improvement Targets After Pediatric Gastrostomy Tube Insertion: A NSQIP-Pediatric Pilot Study.

Background: Gastrostomy tube (GT) placement is one of the most common procedures performed by pediatric surgeons; however, no current national clinical data registry exists to assess GT-specific care processes and morbidity. The American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric (NSQIPPed) GT Pilot was created to provide participants with these data. This study aims to analyze these data to identify variability in perioperative practices and post-operative morbidity in pediatric GT operations and to provide targets for future quality improvement (QI) interventions.

Methods: This retrospective cohort analysis of the ACS NSQIP-Ped database included pediatric surgical patients (0-17 years) who underwent GT placement between January 1, 2023 and December 31, 2023. The analysis focused on perioperative measures, such as preoperative upper gastrointestinal (UGI) study utilization, and postoperative morbidity outcomes, including emergency department (ED) visits related to GT placement and dislodgements.

Results: GT placement represented 5.3 % (8047/151508) of operations submitted to the NSQIP-Ped from all 157 hospitals in 2023. The 71 pilot hospitals that voluntarily participated in this pilot study submitted 57 % (4612/8047) of GT cases, with 77 % (3563/4612) of these cases being first-time GT. UGI studies were obtained in 45 % (1600/3563) of GT cases, with substantial interhospital variability (0-99 %). Postoperative morbidity outcomes included ED visits within 0-30 days in 14 % of GT cases and GT dislodgement in 5.2 % of cases.

Conclusions: Within pediatric GT placement, high variability exists in preoperative UGI use and high postoperative GT-related morbidity, including ED visits and dislodgements among pediatric facilities. The results of this analysis can inform prioritization of future GT QI interventions and research which aim to standardize clinical practice and reduce the incidence of these complications.