38 - Trends in placement of gastrostomy tubes by gestational age: Findings from a US national database study

Publication Number: 4037.38

Matthew Loop, Auburn University, Auburn, AL, United States; Jieun Park, Auburn University, Auburn, AL, United States; Vivek V. Shukla, University of Alabama at Birmingham, Birmingham, AL, United States; Robert T.. Russell, UAB, Birmimgham, AL, United States; Waldemar Carlo, University of Alabama, Birmingham, AL, United States

Background: Gastrostomy tubes (GTs) are essential for infants with persistent inability to achieve full oral feeds, but emerging evidence suggests they may be placed during transient feeding challenges. If present, this trend is concerning because GT placement has risks, including surgical complications, impaired natural feeding skill development, increased healthcare costs, and ongoing logistical burdens for families.

Objective: We examined trends in GT placement rates among infant hospital discharges in the United States from 2003 to 2022 and whether those trends varied by gestational age (GA).

Design/Methods: We used data from the Healthcare Cost and Utilization Project Kids' Inpatient Database to estimate GT placement rate per 1,000 infant discharges from 2003 to 2022. The database collects data every 3 years using stratified sampling among all non-federal hospital pediatric discharges. GA was assigned using ICD9 and ICD10 procedure codes (28 weeks or less, 29 to 32 weeks, 33 to 36 weeks, and 37 weeks or more). We used logistic regression with an interaction between year and GA. Survey methods accounted for the stratified sampling of the database.

Results: The total sample size was 10,826,228 discharges with 87,707 GT placements. After accounting for the stratified sampling, the sample represented a weighted 30,438,620 discharges and 121,062 GT placements. GT placement rates increased among all GAs, with most of the increase occurring after 2012 (see Figure). From 2012 to 2022, GT placement rates increased 4-fold for term and extremely preterm infants. In contrast, GT placement rates increased 11-fold for infants born 29 to 32 weeks GA and 9-fold for infants born 33 to 36 weeks GA. By 2022, GT placement rates per 1,000 infant discharges (95% confidence intervals) reached 89.6 (95% CI: 80.0 to 100.2) for GA 28 weeks or less, 78.6 (95% CI: 68.5 to 90.0) for GA 29 to 32 weeks, 33.6 (95% CI: 29.4 to 38.2) for infants born 33 to 36 weeks, and 1.9 (95% CI: 1.6 to 2.2) for GA 37 weeks or more.

Conclusion(s): GT placement rates have increased in US infants born preterm, especially since 2012. GT placement rates in term infants have stayed constant since 2003. We need research with a detailed, longitudinal follow-up of infants to determine if the clinical "threshold" for recommending GT placement has decreased.

Figure
Trends in G-tube placement rates per 1,000 infant discharges by gestational age.