GA1-50
Retrospective Cohort Study on the Optimal Timing of OGT/NGT Insertion in Infants with Pyloric Stenosis
1Magsino K, 1Lee L, 2Burns R, 3Applegate R, 1Iravani M, 4Dhamrait R, 5Carter H, 5Vadi M, 5Webb L
1UCLA, Los Angeles, CA, US; 2Seattle Children's, Seattle, Washington, US; 3UC David, Sacramento, CA, US; 4UC Davis, Sacramento, CA, US; 5Loma Linda University, Loma Linda, CA, US
Introduction: Hypertrophic pyloric stenosis leads to gastric obstruction and buildup of gastric contents. Historically, these patients presented to the operating room with an orogastric tube (OGT) or nasogastric tube (NGT) in place. Preoperative gastric emptying and improved anesthetic management have virtually eliminated perioperative pulmonary complications. An increasing number of infants are presenting to the operating room without an OGT/NGT in place.
Currently, no clinical guidelines exist addressing the timing of gastric tube placement in these infants. We examined whether having an OGT/NGT placed at time of admission increased time to readiness for surgery in these patients. Secondarily we examined whether having an OGT/NGT placed at time of admission was associated with oral intake intolerance 6 hours post-procedure, increased time from surgery to discharge, or increased hospital stay.
Methods: In this retrospective cohort study, we analyzed medical records of 481 patients who underwent surgery for pyloric stenosis from March 2013 to June 2016. Cox proportional hazard models were constructed to evaluate whether OGT/NGT placement at the time of admission was associated with increased time to readiness for surgery, increased time from surgery to discharge or increased total length of stay. Univariate and multivariate logistic regression were utilized to evaluate the association between OGT/NGT placement and the ability to tolerate oral intake at 6 hours post-op. A sample size of 145 patients in each arm was required to achieve 80% power to find an 8 hour difference in length of stay with an alpha level of 0.05.
Results: 481 patient records were analyzed. 141 patients had OGT/NGTs placed prior to arrival in the operating room while 340 patients did not; 335 patients admitted with normal serum electrolytes were deemed ready for surgery at time of admission, while 146 had abnormal labs and required time for fluid resuscitation. After adjusting for site differences, time to readiness for surgery by labs differed significantly between treatment and non-treatment groups (p=0.001). Of the subset of patients who were ready for surgery at time of admission, actually time to surgery did not differ significantly between treatment and non-treatment groups (p=0.10). Those who had an OGT/NGT placed on arrival or during their admission prior to surgery were twice as likely to be unable to tolerate oral intake within 6 hours compared to those who did not have OGT/NGT placed prior to arrival in the operating room (p=0.004). This effect was more pronounced in the subgroup that was not ready at time of admission, with an odds ratio of 3.89 (0.005). After adjustment for site and readiness for surgery on admission, placement of an OGT/NGT prior to surgery was associated with increased time to discharge after surgery (p=0.001) and increased length of hospital stay (p=0.0002).
Conclusion: Placement of an OGT/NGT prior to surgery appears to be associated with clinically significant increased time to readiness for surgery in the subgroup that was not ready at the time of admission. It is also associated with increased time to discharge after surgery, increased total length of stay, and increased likelihood of oral intake intolerance 6 hours post-op.
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