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Retrospective Cohort Study on the Optimal Timing of Orogastric Tube/Nasogastric Tube Insertion in Infants With Pyloric Stenosis

Lee, Lisa K. MD, MSCR*; Burns, Rebekah A. MD†,‡; Dhamrait, Rajvinder S. MD, FRCA§; Carter, Harmony F. MD; Vadi, Marissa G. MD, MPH§; Grogan, Tristan R. MS; Elashoff, David A. PhD; Applegate, Richard L. II MD§; Iravani, Marc MD*

doi: 10.1213/ANE.0000000000003805
Pediatric Anesthesiology: Original Clinical Research Report
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BACKGROUND: Hypertrophic pyloric stenosis in infants can cause a buildup of gastric contents. Orogastric tubes (OGTs) or nasogastric tubes (NGTs) are often placed in patients with pyloric stenosis before surgical management to prevent aspiration. However, exacerbation of gastric losses may lead to electrolyte abnormalities that can delay surgery, and placement has been associated with increased risk of postoperative emesis. Currently, there are no evidence-based guidelines regarding OGT/NGT placement in these patients. This study examines whether OGT/NGT placement before arrival in the operating room was associated with a longer time to readiness for surgery as defined by normalization of electrolytes. Secondary outcomes included time from surgery to discharge and ability to tolerate feeds by 6 hours postoperatively in patients with and without early OGT/NGT placement.

METHODS: In this multicenter retrospective cohort study, data were extracted from the medical records of 481 patients who underwent pyloromyotomy for infantile hypertrophic pyloric stenosis from March 2013 to June 2016. Multivariable linear regression and Cox proportional hazard models were constructed to evaluate the association between placement of an OGT/NGT at the time of admission with increased time to readiness for surgery (defined as the time from admission to the first set of normalized laboratory values) and increased time from surgery to discharge. Multivariable logistic regression was used to evaluate the association between early OGT/NGT placement and the ability to tolerate oral intake at 6 hours postsurgery. Analyses were adjusted for site differences.

RESULTS: Among patients admitted with electrolyte abnormalities, those with an OGT/NGT placed on presentation required more time until their serum electrolytes were at acceptable levels for surgery by regression analysis (19.2 hours difference; 95% confidence interval, 10.05–28.41; P < .001), after adjusting for site. Overall, patients who had OGTs/NGTs placed before presentation in the operating room had a longer length of stay from surgery to discharge than those without (38.8 hours difference; 95% confidence interval, 25.35–52.31; P < .001), after adjusting for site. OGT/NGT placement before surgery was not associated with failure to tolerate oral intake within 6 hours of surgery after adjusting for site, corrected gestational age, and baseline serum electrolytes.

CONCLUSIONS: OGT/NGT placement on admission for pyloric stenosis is associated with a longer time to electrolyte correction in infants with abnormal laboratory values on presentation and, subsequently, a longer time until they are ready for surgery. It is also associated with longer postoperative hospital stay but not an increased risk of feeding intolerance within 6 hours of surgical repair.

From the *Department of Anesthesiology and Perioperative Medicine, Division of Pediatric Anesthesiology, David Geffen School of Medicine at University of California, Los Angeles, California

Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington

Division of Emergency Medicine, Seattle Children’s Hospital, Seattle, Washington

§Department of Anesthesiology & Pain Medicine, University of California Davis School of Medicine, Sacramento, California

Division of Pediatric Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California

Department of Medicine, Statistics Core, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California.

Published ahead of print 17 August 2018.

Accepted for publication August 17, 2018.

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

L. K. Lee and R. A. Burns contributed equally and share first authorship.

Reprints will not be available from the authors.

Address correspondence to Lisa K. Lee, MD, MSCR, Department of Anesthesiology and Perioperative Medicine, Division of Pediatric Anesthesiology, David Geffen School of Medicine at University of California, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095. Address e-mail to lklee@mednet.ucla.edu.

Copyright © 2018 International Anesthesia Research Society
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