Identifying Quality Improvement Targets After Pediatric Gastrostomy Tube Insertion: A NSQIP-Pediatric Pilot Study

Infographic · Aug 2025 · 1 min read

In brief

Multi-center study of 4,612 pediatric gastrostomy tube placements reveals significant practice variation in preoperative imaging (0-99% UGI utilization) and high postoperative morbidity, with 14% ED visits and 5.2% tube dislodgements within 30 days. Findings identify key targets for standardizing care and reducing complications in this common pediatric surgical procedure.

Preoperative UGI study use varies widely (0-99%) across pediatric hospitals performing 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-Pediatric GT Pilot provides first national registry data to benchmark GT-specific outcomes and identify practice variation.
Standardizing perioperative GT care processes could reduce morbidity in one of the most common pediatric surgical procedures.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with icons representing different surgical procedures. Each column uses distinct colors (blue, green, purple) and includes graphical representations of success percentages, complication rates, and procedural characteristics. Bar charts and circular progress indicators visualize outcome data.

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.

The text in the image

Read it at the source ↗