Health care use stable after feeding tube placement in children with neurologic impairment
The 5-year survival rate in neurologically impaired children after feeding tube placement was 75.8%. There were no significant differences in unplanned hospital days 2 years prior to feeding tube placement compared to 2 years after feeding tube placement.
Study Rundown: Feeding tube placement is a relatively common procedure in children with neurologic impairment (NI). However, less is known at population-level about the long-term mortality and health care use patterns in these patients after feeding tube placement. The researchers in this study aimed to described survival and health care use in children with NI who underwent feeding tube placement between 1993 and 2015 in Ontario, Canada. The 1-year, 2-year, and 5-year survival rates were 91.3%, 87.4%, and 75.8%, respectively. In terms of health care use, there were no significant differences in unplanned hospital days in the 2-year period prior to tube placement compared to the 2-year period after. However, when comparing unplanned hospital days in the 2 year pre-placement versus post-placement period after adjusting for survivor bias, the relative risk (RR) was lower, suggesting that children who died within 1 month of tube placement used more health care than did the other survivors. Secondary outcomes, including reflux-related admissions, emergency department (ED) and outpatient visits, were similar in the pre-placement and post-placement period. Limitations of this study included not stratifying for severity of NI, the use of self-matching design, and the use of coding data that may not adequately portray changes in baseline health status. For pediatricians, this study demonstrates that the rate of mortality is high after tube placement, though it is not necessarily related to the tube placement itself. Unplanned hospital days did not significantly change before and after tube placement in this cohort, which may be helpful information for families with NI children preparing to undergo tube placement.
Click to read the study, published today in Pediatrics
Relevant Reading: Patterns and costs of health care use of children with medical complexity
In-Depth [population-based exposure-crossover]: In a cohort of 1445 children with neurologic impairment who underwent feeding tube placement between 1993 and 2015, 948 were included in the final analysis. For the exposure-crossover, the 2-year period prior to tube placement was considered the baseline interval, while the 2-year period following tube placement was the subsequent interval. The 1-year, 2-year and 5-year survival rates were 91.3% (95%CI = 89.3%-92.9%), 87.4% (95%CI=85.2%-89.4%), and 75.8% (95%CI = 72.8%-78.4%). For the primary outcome of unplanned hospital days, the median number of admissions during the baseline interval was 2 (IQR = 0-3) with a median length of stay (LOS) of 4 days (IQR = 2-9), while the median number of admissions during the subsequent interval was 1 (IQR = 0-3) with a median LOS of 4 days. The adjusted RR for unplanned hospital days was 0.92 (95%CI = 0.57-1.48). In sensitivity analyses adjusting for survivor bias (i.e. exclusion of the 17 patients that died 1 month after tube placement), the RR for unplanned hospital stays was 0.64 (95%CI = 0.44-0.94). For secondary outcomes, there were 526 (22%) of reflux-related admissions with a median LOS of 4 days (IQR = 2-8) in the baseline interval, and 649 with a median LOS of 5 days (IQR = 2-9) in the subsequent interval. In the baseline interval, there were 2375 ED visits without admission and 13 923 outpatient visits compared to 2063 ED visits without admission and 13 727 outpatient visits in the subsequent interval.
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