Trends Gastrostomy Tube Placement and Resource Use in Preterm Infants with Bronchopulmonary Dysplasia in the United States, 2008-2017

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ESPR193
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Abstract: :

Background

Bronchopulmonary dysplasia (BPD) is the most common respiratory complication of prematurity. Some infants with moderate to severe BPD have feeding problems resulting from poor coordination of sucking, swallowing, and breathing, and swallowing dysfunction with silent microaspiration. This sometimes necessitates the surgical placement of a gastrostomy tube (GT) for feeding prior to discharge. However, there is a paucity of data on the trends of GT placement and resource utilization among preterm infants with BPD. 


Objective

To determine the frequency and the trends in GT placement and the associated resource use in preterm infants with BPD in the United States from 2008 through 2017. 


Methods 

We performed a retrospective, serial cross-sectional study using data from the National Inpatient Sample, the largest healthcare database in the US. Inclusion criteria were: GA ≤30 weeks, hospitalization at ≤28 days of age, assignment of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9-CM) or ICD10-CM code for BPD and gastrostomy tube placement. Transfers between facilities were excluded to avoid double counting. The exposure variable was BPD and the primary outcome was GT placement. Secular trends in GT and associated resource utilization were assessed using multivariable logistic regression. P-value <0.05 was considered significant. 


Results

Overall, 3,309 out of 68,953 (4.8%) hospitalizations with BPD had GT placed. Characteristics of the study population: 54.9% were male, 59.9% ≤26 weeks GA; 45.9% White, 64.6% with Medicaid or self-pay, 65.0% in the Midwest and South census regions of the US, and 13.6% had tracheostomy. The proportion of preterm hospitalizations with BPD who had GT increased from 2.45% in 2008-09 to 7.57% in 2016-17 (adjusted odds ratio (aOR 1.11, 95% confidence interval (CI), 1.07-1.15; P <0.001). Pulmonary hypertension (aOR 2.89, 95% CI, 2.36-3.55, P<0.001), care in urban teaching hospital (aOR 1.73, 95% CI, 1.24-2.41, P=0.001), and care in the Midwest (aOR 1.80, 95% CI, 1.32-2.46, P<0.001), South (aOR 1.74, 95% CI, 1.29-2.33, P<0.001), and West (aOR 2.60, 95% CI, 1.89-3.58, P<0.001) census regions were associated with increased odds of GT placement. Tracheostomy placement among those with GT did not significantly change during the study period. For those who survived to discharge, median length of stay increased from 131 in 2008-09 to 147 days in 2016-17 but this was not significant (β = 2.1 days, 95% CI, 0.58-3.6 days, P=0.07). Median inflation-adjusted hospital cost for survivors increased from $272,611 to $386,801 (β = $25,117; 95% CI, $17,008 – 33,226; P <0.001). 


Conclusion 

GT placement in preterm hospitalizations was low but there was an upward trend in the frequency of GT placement and resource use during the study period. The factors leading to this increase need further investigation in order to devise strategies to reduce GT placement in preterm infants with BPD.

Valley Children's Hospital, Madera, CA
Cape Coast Teaching Hospital, Ghanal, Ghana
Korle Bu Teaching Hospital, Ghana
Woodhull Medical and Mental Health Center, NYC, NY
Department of Pediatrics, University of South Florida, Tampa
Department of Pediatrics, United Hospital Center, Bridgeport, WV
University of Kansas School of Medicine-Wichita

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