Surgical Risk, Operative Time, and Anesthesia Time Associated With Combining Tracheostomy and Gastrostomy Tube Placement Under a Single Anesthetic.

INTRODUCTION

Pediatric patients may need both tracheostomy and gastrostomy tube (G-tube) placement to satisfy both oxygen and nutritional requirements for sustaining life. It is unclear if combining both procedures under one anesthetic is associated with reductions in total operative time or surgical risk, compared to performing the two procedures separately.

METHODS

Our study used the 2016-2021 National Surgical Quality Improvement Program-Pediatric Participant Use Files. Patients age 0-2 years were included if they underwent elective tracheostomy or G-tube placement and no concomitant procedures other than direct laryngoscopy or bronchoscopy. The initial cohort included 14,047 patients undergoing G-tube placement only, 571 undergoing tracheostomy only, and 236 undergoing both procedures concurrently. Multivariable analysis used propensity score matching to compare combined procedures to matched synthetic controls, created by combining data from patients undergoing each procedure independently (N = 180 matched pairs).

RESULTS

After matching, combined procedures were associated with lower complication risk (odds ratio: 0.42; 95% confidence interval [CI]: 0.27, 0.65) and reduced anesthesia time (mean difference: 57 min; 95% CI: 47, 68) when compared to synthetic controls, but did not differ on total operative time (mean difference: -4.5 min; 95% CI: -12.6, +3.6).

CONCLUSION

Combined procedures are theorized to reduce risks associated with prolonged exposure to anesthesia. We found a reduction in total anesthesia time associated with combining tracheostomy and G-tube placement under one anesthetic, and lower risk of complications, but no change in total operative time relative to performing 2 separate surgeries.

LEVEL OF EVIDENCE: III.