Postoperative outcomes and health care utilization after gastrostomy in children with autism spectrum disorder and developmental delay.

BACKGROUND

Gastrostomy tube placement is commonly performed in children with autism spectrum disorder, yet it remains unclear whether autism spectrum disorder is independently associated with postoperative outcomes. We compared short-term outcomes after primary gastrostomy tube placement by autism spectrum disorder and developmental delay status.

METHODS

Children (<17 years) undergoing laparoscopic gastrostomy tube placement were identified from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (2019-2024). Patient selection was limited to a single institution (n = 386). Autism spectrum disorder status (confirmed [F84.0] or suspected [R68.89]) solicited from individual medical records was linked to National Surgical Quality Improvement Program-Pediatric data. Primary outcomes were postoperative length of stay and a composite 30-day complication outcome. The relationship between autism spectrum disorder and postoperative outcomes was assessed using multivariable regression, accounting for age, sex, developmental delay, and preoperative nutritional support.

RESULTS

Patients with autism spectrum disorder (n = 82) were older (4.9 vs 1.3 years, P < .001) and more likely to have developmental delay (72% vs 41%, P < .001) than those without. Autism spectrum disorder was not associated with longer length of stay (adjusted geometric means ratio, 0.80; P = .27) or postoperative complications (adjusted odds ratio, 0.98; P = .97). Developmental delay similarly was not associated with longer length of stay (adjusted geometric means ratio, 0.52; P < .001), although it was independently associated with short-term postoperative complications (adjusted odds ratio, 1.94; P < .05). Nutritional support was independently associated with longer length of stay (adjusted geometric means ratio, 1.68; P < .01) and higher odds of complications (adjusted odds ratio, 2.36; P = .02).

CONCLUSION

Autism spectrum disorder is not associated with postoperative length of stay or complications after gastrostomy tube placement. Preoperative nutritional support is strongly associated with postoperative outcomes, suggesting these are driven by overall medical complexity rather than autism spectrum disorder diagnosis.