Identifying Quality Improvement Targets After Pediatric Gastrostomy Tube Insertion | Retrospective cohort analysis | Jan-Dec 2023 | ACS NSQIP-Ped database | 4612 G-tubes | 71 hospitals | 77% first-time G-tubes | G-tube placement is 5.3 % of all operations submitted to the NSQIP-Ped in 2023. | Upper GI studies were ordered in 45% of first-time G-tube placements (interhospital variability=0-99%) | ED visit 30 days post-op: 14% | G-tube dislodgement: 5.2% | Conclusion: Pre-op upper GI use varies widely, with most G-tube morbidity in the first 30 days from ED visits & dislodgements. This analysis highlights the need for standardized practices to guide future quality improvement efforts. | https://pubmed.ncbi.nlm.nih.gov/39743432/ | Moturu A et al. | Division of Research and Optimal Patient Care, American College of Surgeons, USA | Journal of Pediatric Surgery | @LizzyPAC8 | @globalcastmd | @StayCurrentMD | Cincinnati Children's
Identifying Quality Improvement Targets After Pediatric Gastrostomy Tube Insertion: A NSQIP-Pediatric Pilot Study
Infographic · Aug 2025 · 1 min read
In brief
In brief
Multi-institutional analysis of 4,612 pediatric gastrostomy tube placements reveals significant practice variation in preoperative imaging (0-99% UGI utilization) and notable postoperative morbidity, with 14% ED visits and 5.2% tube dislodgements within 30 days. Study identifies key targets for standardization and quality improvement interventions.
- Preoperative UGI study use varies wildly (0-99%) across hospitals performing pediatric GT placement, indicating lack of standardized protocols.
- 14% of pediatric GT patients visit the ED within 30 days post-op, suggesting opportunities to reduce preventable complications.
- GT dislodgement occurs in 5.2% of cases, representing a concrete target for quality improvement interventions.
- NSQIP-Ped GT Pilot provides first national registry data on GT-specific outcomes, enabling evidence-based practice standardization.
- High variability in perioperative practices suggests potential for significant morbidity reduction through protocol standardization.
Written by the GCMD Library team from the infographic.
The infographic uses a teal, light blue, and yellow color scheme with illustrated icons including a physician with an x-ray, a gastrostomy tube diagram, and an ambulance. The layout is divided into sections with statistics presented in large text, culminating in a yellow conclusion box at the bottom. Social media handles and institutional logos appear at the footer.
Anoosha Moturu, Melvin Coleman, Catherine Mets, Vanessa Thompson, Catherine Grant, Clifford Y. Ko, Jacqueline M. Saito, Loren Berman, Derek Wakeman
Background
Gastrostomy tube (GT) placement is one of the most common procedures performed by pediatric surgeons; however, no current national clinical data registry exists to assess GT-specific care processes and morbidity. The American College of Surgeons (ACS) National Surgical Quality Improvement Program–Pediatric (NSQIPPed) GT Pilot was created to provide participants with these data. This study aims to analyze these data to identify variability in perioperative practices and post-operative morbidity in pediatric GT operations and to provide targets for future quality improvement (QI) interventions.
Methods
This retrospective cohort analysis of the ACS NSQIP-Ped database included pediatric surgical patients (0-17 years) who underwent GT placement between January 1, 2023 and December 31, 2023. The analysis focused on perioperative measures, such as preoperative upper gastrointestinal (UGI) study utilization, and postoperative morbidity outcomes, including emergency department (ED) visits related to GT placement and dislodgements.
Results
GT placement represented 5.3 % (8047/151508) of operations submitted to the NSQIP-Ped from all 157 hospitals in 2023. The 71 pilot hospitals that voluntarily participated in this pilot study submitted 57 % (4612/8047) of GT cases, with 77 % (3563/4612) of these cases being first-time GT. UGI studies were obtained in 45 % (1600/3563) of GT cases, with substantial interhospital variability (0-99 %). Postoperative morbidity outcomes included ED visits within 0-30 days in 14 % of GT cases and GT dislodgement in 5.2 % of cases.
Conclusions
Within pediatric GT placement, high variability exists in preoperative UGI use and high postoperative GT-related morbidity, including ED visits and dislodgements among pediatric facilities. The results of this analysis can inform prioritization of future GT QI interventions and research which aim to standardize clinical practice and reduce the incidence of these complications.