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Shehata M, Al Hosani I, Ahmed I, Abu Alkas H, Khaddam O, Aljanahi AA, Al Ahmad M, Al Tiniji K, Singh Y, Malik T. Factors Associated With Short-Term Complications After Percutaneous Endoscopic Gastrostomy Tube Insertion: A Retrospective Cohort Study. Cureus 2024; 16:e55741. [PMID: 38463403 PMCID: PMC10920060 DOI: 10.7759/cureus.55741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) tube placement is generally safe but is associated with a range of complications. Minor complications include infections, granuloma formation, leakage, and blockages, while major complications encompass aspiration pneumonia, hemorrhage, and more serious conditions such as necrotizing fasciitis and colonic fistula. AIM This study aimed to assess the rate of short-term complications within one month of endoscopic PEG insertion, focusing on their correlation with patient characteristics. METHODOLOGY This retrospective cohort study analyzed data from patients who underwent PEG insertion between January 2020 and December 2022. It evaluated the incidence of complications in relation to variables such as the indication for the procedure, the patient's immune status, albumin and CRP levels, and the setting of the procedure (inpatient vs. outpatient). RESULTS The study included 121 patients, with a mean age of 69.73 years, comprising 71 males (58.7%) and 50 females (41.3%). Neurological indications accounted for 64.5% of the cases. Notably, 67.8% of the patients were immunocompromised. Within 30 days of PEG insertion, 16.5% experienced complications, including GI bleeding (4.1%), infection at the PEG site (11.6%), and peritonitis (0.8%). Complications were significantly higher in immunocompromised patients and those with non-neurological indications. Higher serum albumin and lower CRP levels were associated with fewer complications, though the association was not statistically significant. CONCLUSION The study highlights that gastrostomy site infection is the most common short-term complication following PEG insertion. Immune status and the reason for PEG insertion emerged as key factors influencing the likelihood of complications.
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Affiliation(s)
- Mostafa Shehata
- Gastroenterology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, ARE
| | - Ibrahim Al Hosani
- Gastroenterology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, ARE
| | - Ishtiaq Ahmed
- Gastroenterology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, ARE
| | - Heba Abu Alkas
- Gastroenterology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, ARE
| | - Omar Khaddam
- Internal Medicine, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, ARE
| | | | - Maryam Al Ahmad
- Gastroenterology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, ARE
| | - Khalifa Al Tiniji
- Gastroenterology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, ARE
| | | | - Talha Malik
- Gastroenterology, Mayo Clinic, Jacksonville, USA
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Sbeit W, Kadah A, Shahin A, Shbat S, Sbeit M, Khoury T. Scheduled percutaneous endoscopic gastrostomy tube replacement did not reduce PEG-related complications. Scand J Gastroenterol 2021; 56:1386-1390. [PMID: 34420452 DOI: 10.1080/00365521.2021.1965209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) tube insertion is used for enteral nutrition. Each manufacturer has its own instructions for planned tube replacement. Accordingly, caregivers have adopted the policy of elective change at a fixed period of time (3-6 months). AIM The current study aimed to assess whether retained PEG for more than 6 months was associated with a higher rate of PEG-related complications. METHODS A retrospective single-center study included all patients who underwent PEG insertion were included in the study. RESULTS Overall, 303 patients were included, 48 patients (16.2%) had PEG tube replacement. Peristomal PEG tube leak was the commonest complication, occurring in 20 patients (41.7%), followed by dislodgement in 18 patients (37.5%) and obstruction in 10 patients (20.8%). Among the patients with a leak, it occurred within and beyond 6 months from PEG insertion in 40 and 60% of patients, respectively (OR 0.68, 95% CI 0.21-2.18, p = .57). Similarly, 50% of patients had PEG tube obstruction within 6 months and 50% had it beyond 6 months from insertion (OR 1.46, 95% CI 0.34-6.26, p = .72). Moreover, there was no difference in PEG dislodgement after PEG insertion within or beyond 6 months (nine patients, 50% vs. nine patients, 50%), respectively, (OR 1.37, 95% CI 0.42-4.47, p = .76). CONCLUSION Retained PEG tubes for more than 6-months were not associated with more PEG-tube-related complications.
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Affiliation(s)
- Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Anas Kadah
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Amir Shahin
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Samer Shbat
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Department of Anesthesiology, Galilee Medical Center, Nahariya, Israel
| | - Moeen Sbeit
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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Cominardi A, Tamanini G, Brighi N, Fusaroli P, Lisotti A. Conservative management of malignant gastric outlet obstruction syndrome-evidence based evaluation of endoscopic ultrasound-guided gastroentero-anastomosis. World J Gastrointest Oncol 2021; 13:1086-1098. [PMID: 34616514 PMCID: PMC8465451 DOI: 10.4251/wjgo.v13.i9.1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/16/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
Gastric outlet obstruction (GOO) is a clinical syndrome characterized by postprandial vomiting, abdominal pain, bloating and, in advanced cases, by weight loss secondary to inadequate oral intake. This clinical entity may be caused by mechanical obstruction, either benign or malignant, or by motility disorders. In this review we will focus on malignant GOO and on its endoscopic ultrasound (EUS)-guided palliative treatment. The most frequent malignant causes of this syndrome are gastric and locally advanced pancreatic carcinomas; other causes include duodenal or ampullary neoplasms, gastric lymphomas, retroperitoneal lymphadenopathies and, more infrequently, gallbladder and bile duct cancers. Surgery represents the treatment of choice when radical and curative resection is potentially feasible; if the malignant cause is not likely to be completely resected, palliative treatments should be proposed. Palliative treatments for malignant GOO are primarily based on surgical gastro-jejunostomy and endoscopic placement of an enteral self-expanding metal stent. Both treatments are effective; however, endoscopic stent placement is less invasive and it is associated with good short-term results, while surgery provides longer-lasting effects with a lower frequency of reintervention. In the last few years, EUS-guided gastroenterostomy (GE) has been proposed as palliative treatment for malignant GOO. This novel technique consists of the creation of an anastomosis between the gastric lumen and a small bowel loop distal to the malignant obstruction, through the deployment of a lumen-apposing metal stent under EUS-view. EUS-GE has the advantage of being as minimally invasive as enteral stent placement, and of guaranteeing long-term results similar to those of surgery.
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Affiliation(s)
- Anna Cominardi
- Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Giacomo Tamanini
- Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Nicole Brighi
- Department of Medical Oncology, Istituto Scientifico Romagnolo Per Lo Studio Dei Tumori “Dino Amadori” (IRST) IRCCS, Meldola 47014, FC, Italy
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Bologna 40121, Italy
| | - Andrea Lisotti
- Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
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Lima DL, Miranda LEC, da Penha MRC, Lima RNCL, Dos Santos DC, Eufrânio MS, Miranda ACG, Pereira LMMB. Factors Associated with 30-Day Mortality in Patients after Percutaneous Endoscopic Gastrostomy. JSLS 2021; 25:JSLS.2021.00040. [PMID: 34456551 PMCID: PMC8372986 DOI: 10.4293/jsls.2021.00040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Percutaneous endoscopic gastrostomy (PEG) is the main accepted method for long-term tube feeding. The aim of this study is to investigate the risk factors associated with early mortality after PEG. Methods: It is a retrospective survival analysis in a tertiary-level hospital. We reviewed the medical records of 277 patients with PEG placement. The data were analyzed by the Kaplan-Meier method. Multivariable Cox proportional regression models were also built to test the effects of PEG on mortality. Results: A total of 277 patients who submitted to PEG were studied. One-hundred and sixty (58%) were female, mean age of 73.3 ± 15.7 years. Ninety-three patients (33.6%) had diabetes mellitus and 165 (59.6%) had blood hypertension. The indications for PEG placement were chronic neurologic dysphagia in 247 (89.5%) patients and tumors and other diseases in 29 (10.5%). The 30 days proportional mortality probability rate was 13%. In a multivariate Cox proportional regression model, preoperative ICU hospitalization (HR 1.79, 95% CI 1.36–2.36, P = 0.000) and hemoglobin (HR 0.91, 95% CI 0.85–0.98, P = 0.015) were predictors of early mortality. Conclusion: In patients who had underwent PEG tube insertion for long-term nutrition, anemia and previous ICU admission were predictors of mortality at four weeks. These factors may guide physicians to discourage the indication for PEG.
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Affiliation(s)
- Diego L Lima
- Department of Surgery, Montefiore Medical Center, The Bronx, New York, USA
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Cominardi A, Lisotti A, Teci E, Mangano G, Fusaroli P. Elective home replacement of gastrostomy feeding tubes is safe and cost-effective. Has hospital referral become obsolete? Dig Liver Dis 2021; 53:620-624. [PMID: 33384260 DOI: 10.1016/j.dld.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is the technique of choice for providing enteral nutrition in patients with functioning gastrointestinal tract. Available guidelines cover indications and procedural management for PEG placement, while there is no consensus about subsequent replacement with gastrostomy feeding tubes (GFT) and their management. We hypothesized that GFT replacement, according to a standardized protocol supervised by a trained gastroenterologist could be integrated into the home health care system. AIMS To evaluate the safety and cost-efficacy of home GFT replacement. METHODS All consecutive patients who underwent elective home GFT replacements from July 2016 to December 2019 were prospectively enrolled; all procedural details and outcomes have been recorded. RESULTS Overall, 235 GFT replacements in 84 patients [40.5% male, 79.5 (74-94) years] were included. Among these, 230 (97.8%) were completed at patients' home while in five cases (2.2%) patients were referred to the hospital to confirm appropriate GFT placement. No adverse event occurred. An overall cost reduction of 46.8% was obtained, leading to €124 savings per procedure and up to €29,000 savings for the entire study period. CONCLUSIONS When performed electively according to a standardized protocol, home GFT replacement is safe and effective, and leads to relevant cost reduction.
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Affiliation(s)
- Anna Cominardi
- Gastroenterology Unit, Hospital of Imola (BO), University of Bologna, Imola, Italy
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola (BO), University of Bologna, Imola, Italy
| | - Elena Teci
- Gastroenterology Unit, Hospital of Imola (BO), University of Bologna, Imola, Italy
| | - Giovanni Mangano
- Gastroenterology Unit, Hospital of Imola (BO), University of Bologna, Imola, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola (BO), University of Bologna, Imola, Italy.
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Limpias Kamiya KJL, Hosoe N, Takabayashi K, Hayashi Y, Fukuhara S, Mutaguchi M, Nakamura R, Kawakubo H, Kitagawa Y, Ogata H, Kanai T. Factors predicting major complications, mortality, and recovery in percutaneous endoscopic gastrostomy. JGH OPEN 2021; 5:590-598. [PMID: 34013060 PMCID: PMC8114989 DOI: 10.1002/jgh3.12538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/27/2021] [Accepted: 03/18/2021] [Indexed: 12/23/2022]
Abstract
Background and Aim Percutaneous endoscopic gastrostomy (PEG) has been used in patients with dysphagia and inadequate food intake via an oral route. Despite being a procedure with a high success rate, complications and death have been reported. The aim was to identify the factors related to major complications and mortality, as well as PEG removal prognostic factors due to improvement of their general condition. Methods Patient characteristics, comorbidities, laboratory data, concomitant medication, sedation, and indication for PEG placement were collected. Major complications, mortality, and PEG removal factors were assessed. Results A total of 388 patients were enrolled. There were 15 (3.9%) cases of major complications, with major bleeding being the most frequent in 6 (1.5%) patients. Corticosteroids were the independent variable associated with major complications (odds ratio [OR] 5.85; 95% confidence interval [CI] 1.71–20; P = <0.01). Advanced cancer (hazard ratio [HR] 0.5; 95% CI 0.3–1; P = 0.05), albumin (HR 0.6; 95% CI 0.4–0.9; P = <0.01), and C‐reactive protein (CRP) (HR 1.1; CI 1–1.2; P = 0.01) were considered risk factors for mortality. Previous pneumonia (HR 0.4; CI 0.2–0.9; P = 0.02) was a factor for permanent use of a PEG; however, oncological indication (HR 8.2; CI 3.2–21; P = <0.01) was factors for PEG withdrawal. Conclusions Chronic corticosteroid users potentially present with major complications. Low albumin levels and elevated CRP were associated with death. Previous aspiration pneumonia was a factor associated with permanent use of PEG; however, patients with oncological indication were the most benefited.
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Affiliation(s)
- Kenji J L Limpias Kamiya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Keio University School of Medicine Tokyo Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine Tokyo Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine Tokyo Japan
| | - Yukie Hayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Keio University School of Medicine Tokyo Japan
| | - Seiichiro Fukuhara
- Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine Tokyo Japan
| | - Makoto Mutaguchi
- Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine Tokyo Japan
| | - Rieko Nakamura
- Department of Surgery Keio University School of Medicine Tokyo Japan
| | - Hirofumi Kawakubo
- Department of Surgery Keio University School of Medicine Tokyo Japan
| | - Yuko Kitagawa
- Department of Surgery Keio University School of Medicine Tokyo Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine Tokyo Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Keio University School of Medicine Tokyo Japan
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Anderloni A, Di Leo M, Barzaghi F, Semeraro R, Meucci G, Marino R, Amato L, Frigerio M, Saladino V, Toldi A, Manfredi G, Redaelli A, Feliziani M, De Roberto G, Boni F, Scacchi G, Mosca D, Devani M, Arena M, Massidda M, Zanoni P, Ciscato C, Casini V, Beretta P, Forti E, Salerno R, Caramia V, Bianchetti M, Tomba C, Evangelista A, Repici A, Soncini M, Maconi G, Manes G, Gullotta R. Complications and early mortality in percutaneous endoscopic gastrostomy placement in lombardy: A multicenter prospective cohort study. Dig Liver Dis 2019; 51:1380-1387. [PMID: 31010743 DOI: 10.1016/j.dld.2019.03.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is the most common endoscopic procedure used to provide nutritional support. AIM To prospectively evaluate the mortality and complication incidences after PEG insertion or replacement. METHODS All patients who underwent PEG insertion or replacement were included. Details on patient characteristics, ongoing therapies, comorbidities, and indication for PEG placement/replacement were collected, along with informed consent form signatures. Early and late (30-day) complications and mortality were assessed. RESULTS 950 patients (47.1% male) were enrolled in 25 centers in Lombardy, a region of Northern Italy. Patient mean age was 73 years. 69.5% of patients had ASA status 3 or 4. First PEG placement was performed in 594 patients. Complication and mortality incidences were 4.8% and 5.2%, respectively. The most frequent complication was infection (50%), followed by bleeding (32.1%), tube dislodgment (14.3%), and buried bumper syndrome (3.6%). At multivariable analysis, age (OR 1.08 per 1-year increase, 95% CI, 1.0-1.16, p = 0.010) and BMI (OR 0.86 per 1-point increase, 95% CI, 0.77-0.96, p = 0.014) were factors associated with mortality. PEG replacement was carried out in 356 patients. Thirty-day mortality was 1.8%, while complications occurred in 1.7% of patients. CONCLUSIONS Our data confirm that PEG placement is a safe procedure. Mortality was not related to the procedure itself, confirming that careful patient selection is warranted.
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Affiliation(s)
| | - Milena Di Leo
- Humanitas Research Hospital, Rozzano, Italy; Humanitas University, Rozzano, Italy
| | | | | | | | | | | | - Mauro Frigerio
- Azienda Sanitaria Locale della Provincia di Como, Como, Italy
| | | | | | | | | | | | | | - Francesca Boni
- ASST Melegnano e Martesana, Ospedale di Vizzolo Predabissi, Milan, Italy
| | | | | | - Massimo Devani
- ASST Rhodense, Ospedali di Rho e Garbagnate M.se, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Andrea Evangelista
- Unit of Clinical Epidemiology, CPO, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessandro Repici
- Humanitas Research Hospital, Rozzano, Italy; Humanitas University, Rozzano, Italy
| | | | - Giovanni Maconi
- Gastroenterology Unit, FBF - Sacco University Hospital, Milan, Italy
| | - Gianpiero Manes
- ASST Rhodense, Ospedali di Rho e Garbagnate M.se, Milan, Italy
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Shangab MOM, Shaikh NA. Prediction of risk of adverse events related to percutaneous endoscopic gastrostomy: a retrospective study. Ann Gastroenterol 2019; 32:469-475. [PMID: 31474793 PMCID: PMC6686100 DOI: 10.20524/aog.2019.0409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/06/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Percutaneous endoscopic gastrostomy (PEG) is a popular method for long-term enteral feeding. Our aim was to determine potential risk factors for adverse events related to PEG, as well as consequent prolonged hospitalization. Methods: Data were retrospectively collected from the admission records of a tertiary center between July 2015 and June 2018. Possible predictors of the 3 following outcomes were evaluated: minor PEG-related adverse events, major PEG-related adverse events, and length of hospital stay. Data were tested for correlation using the Spearman coefficient and for association using Kruskal-Wallis tests for significance. Results: A total of 362 admissions involving 146 patients were included in the study. Of the admissions, 221 (61.0%) had only minor adverse events, 100 (27.6%) had only major adverse events, and 41 (11.3%) had both. Eighty (22.1%) had PEG-site infection and 128 (35%) had aspiration pneumonia. Serum albumin levels at presentation were negatively correlated with the length of hospitalization (P<0.001), which also differed between patients presenting with major and minor adverse events (P<0.001 and P=0.026). The Charlson comorbidity index was positively correlated with the duration of hospitalization (P<0.001). Higher index scores were found more among patients presenting with aspiration pneumonia (P=0.004) and lower scores were found among patients presenting with PEG site infection and inadvertent PEG removal compared with those presenting with a major complication (P<0.001). Conclusion: The patient’s general medical condition and nutritional status are the greatest risk predictors for developing adverse events related to their PEG feeding, as well as a consequent extended hospital stay.
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Abstract
The global population is aging, and with this demographic shift, the incidence and prevalence of dementia are expected to increase. According to the World Health Organization, an estimated 50 million people are living with dementia worldwide, and this number is expected to triple to 150 million by 2050. Dementia initially affects the brain, eventually affecting the entire body culminating in death, commonly from the complications and comorbidities. People with dementia often experience eating difficulties in addition to a severe decline in cognitive, verbal, and functional abilities secondary to gradual neurodegenerative process, leading to weight loss, malnutrition, and dehydration. When eating difficulties and weight loss occur, health care providers and families often feel obligated to decide to either continue the oral feeding or opt for feeding tube placement. Primary care clinicians, both nurse practitioners and physicians, are presented with challenges when facilitating the decision regarding the feeding options in patients with advanced dementia. This narrative review aims at evaluating the impact of enteral nutrition versus oral feeding by comparing the rates of survival and adverse events in older adults with advanced dementia. It also highlights the best approaches to optimizing nutrition for this frail population.
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Temraz S, Tamim H, Mailhac A, Taher A. Could sodium imbalances predispose to postoperative venous thromboembolism? An analysis of the NSQIP database. Thromb J 2018; 16:11. [PMID: 29988709 PMCID: PMC6029156 DOI: 10.1186/s12959-018-0165-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/01/2018] [Indexed: 12/16/2022] Open
Abstract
Background Hyponatremia is common among patients with pulmonary embolism, while hypernatremia increases the risk of venous thromboembolism (VTE). Our objective was to evaluate the association between sodium imbalances and the incidence of VTE and other selected perioperative outcomes. Methods We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and identified 1,108,704 patients undergoing major surgery from 2008 to 2012. We evaluated 30-day perioperative outcomes, including mortality and cardiac, respiratory, neurological, urinary, wound, and VTE outcomes. Multivariate logistic regressions were used to estimate the odds of 30-day perioperative outcomes. Results Compared with the normal sodium group, in which VTE occurred in 1.0% of patients, 1.8% of patients in the hyponatremia group (unadjusted odds ratio (OR) 1.84) and 2.4% of patients in the hypernatremia group (unadjusted OR 2.49) experienced VTE. Crude mortality was 1.3% in the normal sodium group, 4.9% in the hyponatremia group (unadjusted OR 3.93) and 8.4% in the hypernatremia group (unadjusted OR 7.01). Crude composite morbidity was 7.1% for the normal sodium group, 16.7% for the hyponatremia group (unadjusted OR 2.63) and 20.6% for the hypernatremia group (unadjusted OR 3.43). After adjusting for potential confounders, hyponatremia and hypernatremia remained significantly and independently associated with an increased risk of VTE (adjusted OR 1.43 and 1.56, respectively), mortality (adjusted OR 1.39 and 1.39, respectively) and composite morbidity (adjusted OR 2.15 and 3.34, respectively). Conclusions Pre-operative hyponatremia and hypernatremia are potential prognostic markers for perioperative 30-day morbidity, mortality and VTE.
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Affiliation(s)
- Sally Temraz
- 1Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh 110 72020, Beirut, Lebanon
| | - Hani Tamim
- 1Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh 110 72020, Beirut, Lebanon
| | - Aurelie Mailhac
- 2Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Taher
- 1Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh 110 72020, Beirut, Lebanon
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