Page 109 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

After performing multiple regression analysis, we were able to evaluate parameters associated with lower HRQoL. NI was the main predictor of low HRQoL outcome. No data on health-related quality of life in specific comorbidities are available. However, our findings are in line with findings of another study by Varni et al., reporting on HRQoL assessment in 2500 children among 33 different disease categories. 16 They reported that NI children had the lowest HRQoL out of all disease categories, with a mean HRQoL of 66.85 (± 16.73) in their sample of 245 NI children compared to 82.70 (± 15.40) in their healthy sample. The mean HRQoL in our NI cohort was even lower than that of NI children in the population of Varni et al. This difference may be related to the severity of NI in our study population of children in need of a gastrostomy tube. However, because we do not possess the raw data of the Varni population, we cannot elaborate on this difference with any certainty.
The presence of cardiac disease was also a significant predictor of lower HRQoL after GP in our study, but to a lesser extent than NI. Other morbidity groups were not related to lower outcome in HRQoL in our study.
With respect to patient characteristics, we found that age at the time of operation was a predictor of lower HRQoL, indicating that older children undergoing GP are prone to have lower HRQoL in the long-term. The cause of this relation is unclear. A study performed by Mahant et al. found that children with progressive neurologic disorder had significantly lower HRQoL over time. 11 This may possibly explain the results in our study cohort. As expected, gender and follow-up time did not influence HRQoL.
We investigated gastrostomy-related complications and their correlation with HRQoL. In a previous study, our research group found that a large number of children experience post-GP complications. While the severity of the complications is often minor, they are nevertheless often recurrent and sometimes require reintervention in the OR. 2 These complications may thus have a major impact on everyday life. The impact of these complications on HRQoL of children undergoing GP had never been investigated. In our study, GP-related complications requiring reintervention in the operating theatre were negatively correlated with HRQoL. Surprisingly, this association was not statistically significant (p=0.06) indicating that GP-related complications may have only limited negative influence on HRQoL. Another possible explanation may lie in the long follow-up period of our study of 4.0 years (IQR 2.9 – 6.2). Since most complications occur in the first year after GP, the influence of these complications on HRQoL may diminish over time during follow-up.
A limitation of our study is that it is cross-sectional; it is therefore not possible to determine
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