How many tests does it take? Minimizing preoperative testing prior to surgical placement of gastrostomy tubes in children.

Autor: Tindal EW; Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA., Willis M; Department of Pediatric Gastroenterology, Brown University, Hasbro Children's Hospital/Rhode Island Hospital, Providence, Rhode Island, USA., Recinos Soto A; Department of Pediatric Gastroenterology, Brown University, Hasbro Children's Hospital/Rhode Island Hospital, Providence, Rhode Island, USA., Coyle MG; Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, USA., Herzlinger M; Department of Pediatric Gastroenterology, Brown University, Hasbro Children's Hospital/Rhode Island Hospital, Providence, Rhode Island, USA., Luks FI; Division of Pediatric Surgery, Brown University/Rhode Island Hospital, Providence, Rhode Island, USA.; Division of Pediatric Surgery, Brown University, Hasbro Children's Hospital/Rhode Island Hospital, Providence, Rhode Island, USA., Renaud EJ; Division of Pediatric Surgery, Brown University/Rhode Island Hospital, Providence, Rhode Island, USA.; Division of Pediatric Surgery, Brown University, Hasbro Children's Hospital/Rhode Island Hospital, Providence, Rhode Island, USA.
Jazyk: angličtina
Zdroj: Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition [Nutr Clin Pract] 2023 Apr; Vol. 38 (2), pp. 434-441. Date of Electronic Publication: 2023 Jan 10.
DOI: 10.1002/ncp.10949
Abstrakt: Background: Gastrostomy tubes (GTs) provide life-saving enteral access for children. Although upper gastrointestinal (UGI) series and impedance studies (ISs) detect gastroesophageal reflux disease (GERD) or malrotation, their benefit for preoperative evaluation of asymptomatic patients requiring GT placement is controversial. This study investigated the value of routine preoperative testing and whether specific patient characteristics could guide the selective use of these studies.
Methods: The charts of children who underwent GT placement from 2003 to 2019 were reviewed retrospectively. Demographics, preoperative evaluation, and postoperative course were evaluated.
Results: Three hundred forty-three patients underwent GT placement, 61% with preoperative testing. Seven of 190 UGI (4%) series demonstrated malrotation, and 39 of 141 (28%) ISs revealed severe GERD. Although all malrotations were surgically addressed, only 59% (23/39) of IS-proven GERD cases prompted simultaneous fundoplication. Age <1 year was associated with a positive UGI series (6.7% positive vs 1.0%; P < 0.05), but no other patient characteristics were associated with either positive UGI series or IS. Elimination of the 96% of UGI series that did not alter care represented a cost savings of $89,487-$229,665 and avoided the radiation exposure from testing; elimination of the 84% of ISs that did not alter eventual treatment would have saved $127,776-$266,563.
Conclusion: Routine preoperative evaluation with UGI series and IS can increase healthcare costs without substantially altering care. The only patients potentially benefiting from routine UGI series were <1 year old. Instead, a targeted, symptom-based preoperative evaluation may streamline the process by decreasing preoperative testing and minimizing cost and radiation exposure.
(© 2023 American Society for Parenteral and Enteral Nutrition.)
Databáze: MEDLINE
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