Surgical risk stratification and outcome analysis of Tenckhoff catheter implantations in paediatric patients: a single-centre experience.

Abstract

This study aimed to assess the risk factors for complications post-Tenckhoff catheter implantation in paediatric patients. All records of children who underwent the procedure from 2002 to 2022 at the University Medical Centre of Hamburg were analyzed. The demographic and anthropometric characteristics were scrutinized, with particular attention given to complications such as catheter leakage, occlusions, and peritonitis. Univariate and multivariate analyses were employed to determine the hazard ratios for complications. In total, 299 implantations were performed in 116 females and 130 males; 67% were under 5 years old, and 85% had renal disease. Fifty-one percent needed an acute catheter insertion, 26% of the patient's required revision, and 24% of the patients experienced peritonitis. Neonates had a 22% mortality rate, and infants had a 37% reimplantation rate. Compared with the other subgroups, a glomerular filtration rate of 15-29 ml/kg/1.7 3m² was associated with a 10.7-fold higher risk of peritonitis. Male patients had a threefold greater chance of reimplantation or inguinal hernia. Omentectomy revealed no increased risk of peritonitis, and only two catheter occlusions were observed. Patients with inguinal hernias or gastric tubes had higher odds of complications (HR = 3.60, p = 0.003 and OR = 2.47, p = 0.014). Neither the implantation side nor acute insertion was correlated with complications.

Conclusion: Infants, male patients with kidney disease, prolonged use of catheter, and those with a GFR of 15-29 ml/kg/1.73 m² were at increased risk. The presence of peritonitis, inguinal hernia, and gastric tubes were adverse prognostic factors.

What is known: • Omentectomy can serve as a protective factor and correlates with a lower incidence of catheter malfunction. • The insertion of gastric tubes is commonly associated with complications but has lower risk of complications if inserted prior to the initiation of peritoneal dialysis.

What is new: • Males have been found to have a 2.14 hazard ratio for revision in both acute and chronic peritoneal dialysis groups. • The incidence of revisions seems to be greater in the first 36 months, while the incidence of peritonitis rises by 7% for each additional year of age.