Gastrostomy Tube Placement in Patients With Trisomy 13 and 18: Surgical Decision Making and Outcomes.

PURPOSE: Trisomy 13 (T13) and trisomy 18 (T18) are chromosomal abnormalities which portend high rates of feeding dysfunction and infant mortality risk. Although gastrostomy tube (GT) placement is commonly performed in this population, there is limited data assessing outcomes associated with this procedure. Our aim was to determine survival outcomes among GT and non-GT patients with T13/18.

METHODS

We performed a retrospective cohort study of patients with T13 and T18 treated at our institution from 2005 through 2020. We compared baseline characteristics and survival data between GT and non-GT patients and performed multivariable survival analysis.

RESULTS

We analyzed a total of 86 patients (23 GT, 63 non-GT). Over one-third of GT patients underwent the procedure during initial admission and most GTs were used for longer than one year (60.9 %). Significantly more GT patients survived initial discharge (87 % vs. 57.1 %, p < 0.001) and were alive at follow-up (43.5 % vs. 6.3 %, p < 0.001) compared to non-GT patients. Thirty-day post-discharge survival was determined solely by GT status and not impacted by predictors. GT patients had reduced overall mortality risk compared to non-GT patients in the first year of life (HR = 0.10 [95 % CI 0.04-0.29], p < 0.001) and during the fifteen-year study period (HR = 0.15 [95 % CI 0.06-0.35], p < 0.001).

CONCLUSIONS

GT status predicted 30-day post-discharge survival in our cohort. GT patients had reduced overall mortality risk compared to non-GT patients. In patients with expected survival to initial discharge and feeding difficulty, GT placement at or after initial admission may be associated with improved survival outcomes.

LEVEL OF EVIDENCE: III.