O2173: Concomitant intraabdominal procedures do not increase risk of peritoneal dialysis catheter infection

Background: Peritoneal dialysis (PD) is the preferred mechanism of renal replacement therapy in children. Because end stage renal disease is often accompanied by protein loss, anorexia, and malnutrition, many children who undergo PD also require gastrostomy placement. Due to concerns for catheter associated infections, PD catheter insertion is frequently delayed several weeks following gastrostomy to allow for the tract to matue and decrease the risk of peritoneal contamination. Most data available to guide surgeons regarding the safety of performing clean-contaminated procedures in the abdomen at the same time as PD catheter insertion come from small single institution retrospective series with variable results. We hypothesized there would be no differences in outcomes, particularly deep space surgical site infections (SSI), when comparing isolated PD catheter procedures with those performed with gastrostomy tube insertion.

Methods: A retrospective analysis was performed using the Pediatric National Surgical Quality Improvement Program (NSQIP) public use files. Inclusion criteria were patients 0-18 years old undergoing PD catheter placement alone or PD catheter placement with concomitant gastrostomy tube, as defined by CPT codes, between 2016-2021. Patients undergoing concomitant procedures besides gastrostomy tube placement were excluded. The primary outcome was organ space SSI within 30 days of placement, with secondary outcomes of superficial SSI, unplanned readmissions, and reoperation within 30 days of placement.

Results: There were 969 patients who underwent PD catheter placement in isolation at the index operation, 92 had a PD catheter placed at the same time as insertion of a gastrostomy tube, and 711 were excluded for non-gastrostomy tube concomitant procedures. Of those undergoing PD catheter placement with concomitant gastrostomy tube insertion, 22 patients underwent open gastrostomy tube, 66 patients underwent laparoscopic gastrostomy tube, and 4 patients underwent percutaneous endoscopic gastrostomy tube insertion. Compared to patients undergoing isolated PD catheter placement, those who underwent combined PD catheter and gastrostomy tube placement had no significant difference in incidence of 30-day organ space SSI (3.6% vs 2.2%, p=0.47), superficial SSI (2.0% vs 3.3%, p=0.40), unplanned readmission (12.6% vs 9.8%, p=0.43), or reoperation (14.2% vs 17.4%, p=0.41). Multivariate logistic regression controlling for age, sex, and weight showed there were no significant differences in the primary or secondary outcomes when comparing those undergoing isolated PD catheter placement and those undergoing concurrent PD catheter and gastrostomy tube placement.

Conclusion: Peritoneal dialysis and the longevity of a PD catheter is an important lifeline for children who require renal replacement therapy. Due to fear of infection, surgeons may opt to perform PD catheter placement separately from other intra-abdominal surgeries. This requires additional episodes of anesthesia and can delay the start of dialysis or necessitate bridge use of hemodialysis. These data suggest it is feasible to perform PD catheter placement at the same time as other clean-contaminated intraabdominal procedures.