Decreased Health Care Resource Utilization in Children With Planned Gastrojejunostomy Tube Exchanges.

INTRODUCTION

Gastrojejunostomy tubes (GJTs) provide enteral nutrition in infants and children with gastric feeding intolerance, but are prone to device-related complications. There are no widely accepted guidelines regarding timing of GJT exchange. We hypothesized that patients with increased scheduled GJT exchanges would have decreased overall health care resource utilization compared to patients with less planned exchanges.

METHODS

A single-institution retrospective analysis of a prospectively maintained registry of children undergoing GJT exchange by a surgical service from 2018 to 2023. Multivariable models evaluated length of stay, fluoroscopy time, and inflation-adjusted encounter cost, adjusting for age, weight, Child Opportunity Index, and comorbidity burden.

RESULTS

Seventy-one patients underwent 472 GJT exchanges (219 planned and 253 unplanned). Compared with planned exchanges, unplanned exchanges were associated with longer length of stay (adjusted ratio [aR] 2.43, 95% confidence interval [CI] 2.14-2.76), greater fluoroscopy time (aR: 4.40, 95% CI: 3.10-6.24), and 30% higher encounter costs (aR: 1.3, 95% CI: 1.12-1.51; all P < 0.001). Compared with <1 planned exchange/y, 1-2 and >2 planned exchanges/y were associated with 52% and 63% lower rates of unplanned exchange, respectively (both P < 0.001). Each additional planned exchange per patient-year was associated with a 44% lower unplanned exchange rate (incidence rate ratio: 0.56, 95% CI: 0.46-0.69; P < 0.001). Median patient-level time to device failure was 3 mo (interquartile range: 1.9-4.0).

CONCLUSIONS

Planned GJT exchanges were associated with lower health care resource utilization. Defining the optimal interval should be individualized; however, beginning with an exchange at 3 mo and targeting 2-3 exchanges annually at 3-6 mo intervals may provide an initial framework to adjust or extend to meet each patient's needs.