Page 121 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

We found that children undergoing GP significantly improved in the subdomain of psychosocial HRQoL. This was mainly based on an improvement in social HRQoL. Social HRQoL comprises the ability to function as other children of the same age. Presumably, GP helps children participate in normal daily life. This is an important finding for patients, caregivers and treating physicians when children are referred for GP.
Physical and overall HRQoL, however, remained unchanged after GP. This may be explained by the fact that physical HRQoL is heavily affected by the child’s primary health condition. 14 The benefits of GP are therefore not sufficient to improve overall HRQoL in these patients. In our prediction model of HRQoL we found that NI was the main predictor of lower overall HRQoL, with the largest effect size for physical HRQoL. This is in line with a cross-sectional study analyzing 150 patients four years (IQR 2.9 – 6.2) after GP. The predictive value of cardiac morbidity on HRQoL did not reach statistical significance (p=0.09).
Physical health summary scores increased with higher age at the time of operation, indicating that children over time gain more physical well being, possibly due to natural growth or medical assistance.
In our prediction model of postoperative changes in HRQoL, we found that the only predictor of change in HRQoL was preoperative BMI: children with lower preoperative BMI showed the largest improvement in HRQoL. This is in line with our hypothesis that children with the worst feeding difficulties gained the most benefit from a gastrostomy tube. Even though NI was predictive of lower HRQoL, NI by itself did not influence the effect of GP on HRQoL.
Pediatric self-report is the standard for HRQoL measurement. However, in young children or in children with NI it can be difficult to obtain self-reports from children. Various studies on HRQoL in children indicate that caregivers’ proxy-report does not always correspond to what children report themselves. 15 We found that patients consistently reported higher levels of HRQoL in comparison to their caregivers, although this was not statistically significantly different. This may be attributed to a small effect size or to the small number of children who were able to self-report on their HRQoL (27.5%), which was due to the large proportion of NI children in our study population. Similar effects were found in another study in pediatric patients undergoing laparoscopic antireflux surgery, where patient’s self- report of total HRQoL scores was significantly higher than parental proxy-report with small differences between both groups. 16,17
Because of the heterogeneity of our patient group, the results of this study can be applied to all children undergoing GP. However, a limitation of our study is that the heterogeneity
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