(10 - Saturday) Retrospective analysis of children with congenital heart surgery undergoing gastrostomy tube surgery alone vs. concurrent gastrostomy tube and Nissen fundoplication

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Abstract: Retrospective analysis of children with congenital heart surgery undergoing gastrostomy tube surgery alone vs. concurrent gastrostomy tube and Nissen fundoplication

Authors: Colin Meyer-Macaulay, Ryan Hessenius, Ellen Spurrier, Erica Del-Grippo, Claude Beaty Jr, Kirk Reichard

Introduction/

Objective: Gastrostomy tube (GT) and Nissen fundoplication (NF) are commonly performed in children with congenital heart disease (CHD). GT with concurrent NF (GT/NF) is often done, but its impact on important outcomes is unclear. Our primary objective was to investigate the impact of GT/NF in patients with CHD on length of stay (LOS), weight for age Z-scores, post-operative complications, duration of mechanical ventilation (MV), time to full enteral feeds, and mortality when compared to GT alone. Our secondary objective was to investigate which clinical features or preoperative diagnostic evidence are associated with GT placement versus concurrent GT/NF.

Methods: Retrospective chart review of children aged 0-18 with CHD who underwent GT or GT/NF at a single center from 2010-2020. We compared continuous variables using student’s T-test or Wilcoxon-Rank sum test, and categorical variables using X-squared test. We used univariate regression analysis to compare the impact of risk factors and pre-operative investigations on GT or GT/NF status. We then applied multivariable regression analysis including any statistically significant variables on risk factor analysis. We used Kaplan-Meier survival analysis to compare survival based on GT or GT/NF status.

Results: 196 patients total; 68 underwent GT (34.7%); 127 (64.8%) underwent GT/NF. One underwent NF only; 1 underwent NF at a later date. Mortality did not differ between the 2 groups. Total LOS, time to reach full feeds, LOS post GT, and duration of MV were all increased in the GT/NF group. Weight at 6 months (mos) following GT was less in the GT/NF group; weight for age Z-score and change in weight for age Z-score 6 mos following GT did not differ. Normal upper gastrointestinal (UGI) study was associated with lower likelihood of GT/NF; reflux with a higher likelihood (Table 1). After multivariate regression analysis, only weight and clinical diagnosis of reflux remained significantly associated with GT/NF (Table 2). Survival was no different between the 2 groups (Fig. 1)

Conclusions: GT/NF is associated with longer length of stay, duration of MV and longer time to reach full feeds but not with mortality, survival, or surgical complication rate. Lower weight and clinical diagnosis of reflux are associated with increased likelihood of GT/NF. Pre-operative UGI was associated with likelihood of GT/NF.