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Skogar ML, Sundbom M. Time trends and outcomes of gastrostomy placement in a Swedish national cohort over two decades. World J Gastroenterol 2024; 30:1358-1367. [PMID: 38596497 PMCID: PMC11000080 DOI: 10.3748/wjg.v30.i10.1358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/27/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) and laparoscopically inserted gastrostomy have become the gold standard for adult patients and children, respectively, requiring long-term enteral nutrition support. Procedure-related mortality is a rare event, often reported to be zero in smaller studies. National data on 30-d mortality and long-term survival rates after gastrostomy placement are scarce in the literature. AIM To study the use of gastrostomies in Sweden from 1998-2019 and to analyze procedure-related mortality and short-term (< 30 d) and long-term survival. METHODS In this retrospective, population-based cohort study, individuals that had received a gastrostomy between 1998-2019 in Sweden were included. Individuals were identified in the Swedish National Patient Register, and survival analysis was possible by cross-referencing the Swedish Death Register. The cohort was divided into three age groups: Children (0-18 years); adults (19-64 years); and elderly (≥ 65 years). Kaplan-Meier with log-rank test and Cox regression were used for survival analysis. RESULTS In total 48682 individuals (52% males, average age 60.9 ± 25.3 years) were identified. The cohort consisted of 12.0% children, 29.5% adults, and 58.5% elderly. An increased use of gastrostomies was observed during the study period, from 13.7/100000 to 22.3/100000 individuals (P < 0.001). The use of PEG more than doubled (about 800 to 1800/year), with a corresponding decrease in open gastrostomy (about 700 to 340/year). Laparoscopic gastrostomy increased more than ten-fold (about 20 to 240/year). Overall, PEG, open gastrostomy, and laparoscopic gastrostomy constituted 70.0% (n = 34060), 23.3% (n = 11336), and 4.9% (n = 2404), respectively. Procedure-related mortality was 0.1% (n = 44) overall (PEG: 0.05%, open: 0.24%, laparoscopic: 0.04%). The overall 30-d mortality rate was 10.0% (PEG: 9.8%, open: 12.4%, laparoscopic: 1.7%) and decreased from 11.6% in 1998-2009 vs 8.5% in 2010-2019 (P < 0.001). One-year and ten-year survival rates for children, adults, and elderly were 93.7%, 67.5%, and 42.1% and 79.9%, 39.2%, and 6.8%, respectively. The most common causes of death were malignancies and cardiovascular and respiratory diseases. CONCLUSION The annual use of gastrostomies in Sweden increased during the study period, with a shift towards more minimally invasive procedures. Although procedure-related death was rare, the overall 30-d mortality rate was high (10%). To overcome this, we believe that patient selection should be improved.
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Affiliation(s)
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala 75185, Sweden
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Elghezewi A, Hammad M, Mohamed M, Chirico P, Frandah W. A Rare Case of Anterograde Gastroduodenal Intussusception Caused by Migrated Percutaneous Endoscopic Gastrostomy Feeding Tube. J Med Cases 2023; 14:169-173. [PMID: 37303971 PMCID: PMC10251706 DOI: 10.14740/jmc4101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023] Open
Abstract
Gastroduodenal intussusception is a critical condition in which stomach protrudes into the duodenum. It is a very rare condition in adults. Most common causes include intra luminal lesions in the stomach including benign or malignant tumors of the stomach. Most common tumors included are gastrointestinal stromal tumors (GISTs), gastric carcinoma, gastric lipoma, gastric leiomyoma, and gastric schwannoma. It is extremely rare to be caused by migration of percutaneous feeding tube. A 50-year-old woman with a past medical history (PMH) of dysphagia status post percutaneous endoscopic gastrostomy (PEG) tube, history of spastic quadriplegia, presented with acute nausea, vomiting and abdominal distention, and was found to have gastroduodenal intussusception in computed tomography (CT) scan. Condition resolved after retracting PEG tube. Endoscopy did not reveal any intra luminal lesions. External fixation using Avanos Saf-T-Pexy T-fasteners was performed to prevent recurrence of this condition. Most common of causes of gastroduodenal intussusception are GIST tumors of stomach. CT abdomen is the most accurate test and upper endoscopy is needed to rule out any intra luminal causes. Treatment of choice is either endoscopic or surgical resection. External fixation is essential to prevent recurrence.
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Affiliation(s)
- Abdelwahap Elghezewi
- Department of Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA
| | - Mohamed Hammad
- Department of Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA
| | - Mujtaba Mohamed
- Section of Gastroenterology and Hepatology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA
| | - Peter Chirico
- Department of Radiology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA
| | - Wesam Frandah
- Section of Gastroenterology and Hepatology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA
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3
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Marlor DR, Taghlabi KM, Hierl AN, Braasch MC, Winfield RD. In-hospital, 30- and 90-day mortality in elderly trauma patients with operative feeding tubes. Am J Surg 2023; 225:758-763. [PMID: 36404168 DOI: 10.1016/j.amjsurg.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nutrition is essential in the treatment of elderly trauma patients (ETP). ETP experience dysphagia at rates six times higher than the non-trauma elderly population (NTEP) and are at increased risk for malnutrition. Operative feeding tube (OFT) placement is often used to aid with the nutritional management of ETP. Elderly patients experience higher rates of morbidity and mortality when compared to the general population, especially in the traumatic setting, with some data suggesting in-hospital mortality as high as 10%. However, the mortality rates and associated comorbidities associated with OFT in ETP are unknown. The purposes of this study were to establish the mortality rate in hospital as well as 30- and 90-days following discharge among elderly trauma patients (ETP) receiving OFT, and to assess factors associated with mortality within this population. METHODS A retrospective review of all trauma patients from a single Level I Trauma Center from 01/2010-09/2020 was conducted. Exclusion criteria were patients under 65 years of age or those with previously placed OFT. Demographics, comorbidities, injury mechanisms, injury severity scores (ISS), and OFT data were collected from the institutional trauma registry. Mortality data were obtained using the Social Security Death Index. Mortality at discharge, 30 days, and 90 days following discharge were the primary outcomes. Bivariate analysis was conducted to compare characteristics and comorbidities of patients alive and dead at the time points of interest. RESULTS There were 151 ETP who received OFT. Patients were largely male (67.5%), severely injured via a blunt mechanism (95%), and had a median age of 76 years. 11 (7.3%) experienced in-hospital mortality following feeding tube placement, 21 (13.9%) died within 30 days, and 31 (20.5%) within 90 days. Bivariate analysis demonstrated that ETP who died were more likely to have a history of dementia (p = 0.004), congestive heart failure (p = 0.014), and end-stage liver disease (p = 0.034). No other patient or injury factors were associated with mortality after OFT placement. CONCLUSION Mortality rates for ETP with OFT were higher than anticipated, yet favorable compared to recently reported data. Patients who died were more likely to have dementia, CHF, or ESLD than those who survived. The few comorbidities associated with mortality suggest that nearly all ETP who undergo OFT placement are at risk for mortality. Additionally, the data highlights the importance of early goals of care discussions for ETP and their loved ones when operative feeding tubes are being considered. LEVEL OF EVIDENCE Level III. STUDY TYPE Prognostic/Therapeutic/Diagnostic Test/Economic/Decision.
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Affiliation(s)
- Derek R Marlor
- University of Kansas Medical Center, Trauma, Surgical Critical Care and Acute Care Surgery, Kansas City, KS, USA.
| | - Khaled M Taghlabi
- University of Kansas Medical Center, Trauma, Surgical Critical Care and Acute Care Surgery, Kansas City, KS, USA.
| | | | | | - Robert D Winfield
- University of Kansas Medical Center, Trauma, Surgical Critical Care and Acute Care Surgery, Kansas City, KS, USA.
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Stenberg K, Eriksson A, Odensten C, Darehed D. Mortality and complications after percutaneous endoscopic gastrostomy: a retrospective multicentre study. BMC Gastroenterol 2022; 22:361. [PMID: 35902805 PMCID: PMC9335963 DOI: 10.1186/s12876-022-02429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Percutaneous endoscopic gastrostomy (PEG) is the method of choice for patients in need of long-term nutritional support or gastric decompression. Although it is considered safe, complications and relatively high mortality rates have been reported. We aimed to identify risk factors for complications and mortality after PEG in routine healthcare. Methods This retrospective study included all adult patients who received a PEG between 2013 and 2019 in Region Norrbotten, Sweden.
Results 389 patients were included. The median age was 72 years, 176 (45%) were women and 281 (72%) patients received their PEG due to neurological disease. All-cause mortality was 15% at 30 days and 28% at 90 days. Malignancy as the indication for PEG was associated with increased mortality at 90 days (OR 4.41, 95% CI 2.20–8.88). Other factors significantly associated with increased mortality were older age, female sex, diabetes mellitus, heart failure, lower body mass index and higher C-reactive protein levels. Minor and major complications within 30 days occurred in 11% and 15% of the patients, respectively. Diabetes increased the risk of minor complications (OR 2.61, 95% CI 1.04–6.55), while those aged 75 + years were at an increased risk of major complications, compared to those younger than 65 years (OR 2.23, 95% CI 1.02–4.85). Conclusions The increased risk of death among women and patients with malignancy indicate that these patients could benefit from earlier referral for PEG. Additionally, we found that age, diabetes, heart failure, C-reactive protein and body mass index all impact the risk of adverse outcomes.
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Affiliation(s)
- K Stenberg
- Department of Surgery, Sunderby Hospital, Kirurgkliniken, Sunderby sjukhus, Sjukhusvägen 10, 954 42, Södra Sunderbyn, Sweden.
| | - A Eriksson
- Department of Surgery, Sunderby Hospital, Kirurgkliniken, Sunderby sjukhus, Sjukhusvägen 10, 954 42, Södra Sunderbyn, Sweden
| | - C Odensten
- Department of Surgical and Preoperative Sciences, Surgery, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - D Darehed
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
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5
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Braasch MC, Taghlabi KM, Marlor DR, Hierl AN, Winfield RD. Defining the Mortality Rate of Elderly Trauma Patients With Operative Feeding Tubes. Am Surg 2022:31348221096572. [PMID: 35482961 DOI: 10.1177/00031348221096572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Placement of feeding tubes in elderly patients has not been studied in elderly trauma patients. The objectives of this study were to determine in-hospital mortality in elderly trauma patients receiving operative feeding tubes and to identify factors associated with in-hospital mortality. METHODS A retrospective study utilizing 2017 National Trauma Data Bank data was conducted. Trauma patients aged 65 and older with operative feeding tubes were included. Demographic, injury, comorbidity, and general hospital course data were analyzed. Two cohorts were constructed: survival and non-survival to hospital discharge. Bivariate analysis and logistic regression were performed to determine factors independently associated with in-hospital mortality. RESULTS A total of 3,398 patients were analyzed with 331 (9.7%) dying during hospitalization. Patients had a median age of 75 years and sustained severe injuries (median ISS 17). Patients who died were older (76 vs. 75 years, p = .03), more severely injured (ISS 22 vs. 17, p < .001), had a higher geriatric trauma outcome score (134 vs. 121, p < .001), and had lower rates of dementia (8 vs. 13%, p = .01). Multivariate regression showed male sex, lower admission GCS, higher Charlson Comorbidity Index, and an Advance Directive Limiting Care (ADLC) were independently associated with in-hospital mortality. Dementia diagnosis was negatively associated with in-hospital mortality. CONCLUSIONS The in-hospital mortality rate for elderly trauma patients with operative feeding tubes placed was notably high. Identifying factors associated with in-hospital mortality will serve to assist providers in counseling patients and caregivers about the outcomes of operative feeding tube placement in this patient population.
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Affiliation(s)
- Maxwell C Braasch
- 21638The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Khaled M Taghlabi
- Department of Surgery, Division of Trauma, Acute Care, & Critical Care Surgery, 21638The University of Kansas Health System, Kansas City, KS, USA
| | - Derek R Marlor
- Department of Surgery, Division of Trauma, Acute Care, & Critical Care Surgery, 21638The University of Kansas Health System, Kansas City, KS, USA
| | - Anneliese N Hierl
- 21638The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Robert D Winfield
- Department of Surgery, Division of Trauma, Acute Care, & Critical Care Surgery, 21638The University of Kansas Health System, Kansas City, KS, USA
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ESPEN practical guideline: Clinical nutrition and hydration in geriatrics. Clin Nutr 2022; 41:958-989. [DOI: 10.1016/j.clnu.2022.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
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Abstract
Dementia is a progressive, irreversible illness and leading global cause of death defined by cognitive and subsequent functional decline. Current treatments have limited impact on mortality. In this chapter, we discuss the trajectory of dementia and its variability, markers associated with poorer prognosis (such as poor nutrition, pneumonia, comorbid conditions), the impact of hospitalization on prognosis, and current models of end-of-life palliative care/hospice eligibility (with the use of the Functional Assessment Staging tool and other markers). We then discuss strategies to discuss prognosis with patients and their healthcare proxies using a mental model (Ask, Discover, Anticipate, Provide, Track: ADAPT) and specific skills. Because of progression of dementia variability, prognosis is better discussed in terms of function. For patients with dementia, initiating advance care planning earlier in their disease course allows for more patient involvement (such as to identify a surrogate decision maker).
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Affiliation(s)
- Sinthana U Ramsey
- Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States; Palliative and Supportive Institute, UPMC Health System, Pittsburgh, PA, United States
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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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Miranda LE, Penha MRCD, Miranda ACG, Lima DL, Costa MWF, Amorim ADO. RISK FACTORS ASSOCIATED WITH EARLY MORTALITY AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN PATIENTS AT A TERTIARY CARE CENTER IN BRAZIL: A RETROSPECTIVE SINGLE-CENTER SURVIVAL STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2020; 56:412-418. [PMID: 31800738 DOI: 10.1590/s0004-2803.201900000-83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/14/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is the main accepted method for long-term tube feeding. OBJECTIVE To investigate the risk factors associated with early mortality after PEG. METHODS Retrospective survival analysis in a tertiary-level center in Recife, Brazil. We reviewed the medical records of 150 patients with PEG placement. The data were analysed 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 150 patients who submitted to PEG were studied (70 male). Of the participants, 87 (58%) had blood hypertension; 51 (34%) patients had diabetes; 6 (4%) patients had chronic renal disease; and 6 (4%) had malignancy. Chronic neurodegenerative diseases were the more common clinical indication for PEG. The 30-day and 60-day proportional mortality probability rates were 11.05% and 15.34% respectively. A multivariate Cox proportional regression model, haemoglobin (HR 4.39, 95%CI 1.30-14.81, P=0.017) and pre-procedure UCI staying (HR 0.66, 95% CI 0.50-0.87, P=0.004) were significant predictors of early mortality.A haemoglobin cut-off value of 10.05 g/dL was shown to have a sensibility of 82.6% (61.2% to 95% CI) and an acceptable sensitivity of 59.0 (50.6% to68.6% CI), and a likelihood ratio of 2.06 for eight weeks mortality. CONCLUSION In patients who had been subjected to the PEG procedure for long-term nutrition, low haemoglobin, pre-procedure intensive care unit internment or both are associated with the risk of early mortality.
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Affiliation(s)
- Luiz Eduardo Miranda
- Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Departamento de Cirurgia Geral e Transplante Hepático, Recife, PE, Brasil
| | - Marcel Rolland Ciro da Penha
- Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Departamento de Cirurgia Geral e Transplante Hepático, Recife, PE, Brasil
| | | | - Diego Laurentino Lima
- Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Departamento de Cirurgia Geral e Transplante Hepático, Recife, PE, Brasil
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Survival outcomes of percutaneous endoscopic gastrostomy, comparison of cerebrovascular event and non-cerebrovascular event in malnourished patients. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.581155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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11
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Nosocomial Infections among Patients with Intracranial Hemorrhage: A Retrospective Data Analysis of Predictors and Outcomes. Clin Neurol Neurosurg 2019; 182:158-166. [PMID: 31151044 DOI: 10.1016/j.clineuro.2019.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/15/2019] [Accepted: 05/18/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Intracranial hemorrhage is a critical medical emergency. Nosocomial infections may promote worse outcomes in these vulnerable patients. This study investigated microbial features, predictors, and clinical outcomes of nosocomial infections among patients with multiple subtypes of intracranial hemorrhage. PATIENTS AND METHODS We conducted a retrospective cohort study of patients that were hospitalized with intracranial hemorrhage between January 2015 and October 2018, and divided them into two groups based on the development of nosocomial infection. Within the cohort of patients with nosocomial infections, microbiology and resistance patterns were established across multiple sites of infection. Moreover, consequences of nosocomial infection such as mortality and length of hospital stay were determined. RESULTS A total of 233 cases were identified that met our inclusion and exclusion criteria out of which were 94 cases of nosocomial infection (40.3%) versus 139 cases with no nosocomial infection (59.7%). The most common infections were pneumonia, urinary tract infections, and bacteremia. Resistance accounted for 70.2% of cultures. Multivariable analysis revealed significant association of nosocomial infections with hypertension (OR: 2.62, 95% CI: 1.11-6.16, p = 0.027), hospital LOS (OR: 1.08, 95% CI: 1.05-1.12, p < 0.001), levetiracetam (OR: 3.6, 95% CI: 1.41-0.922, p = 0.007), and GCS category (OR: 5.42, 95% CI: 1.67-17.55, p = 0.005 and OR: 7.63, 95% CI: 2.44-23.87, p < 0.001 for moderate and severe, respectively). Patients with nosocomial infections witnessed a significant increase in the length of hospital stay (23 versus 8 hospital days, p < 0.001). This finding was significant across most types of brain hemorrhage. Mortality was significantly associated with GCS category (OR: 10.1, 95% CI: 4-25.7, p < 0.001) and percutaneous endoscopic gastrostomy tube insertion (OR: 19.6, 95% CI: 4.1-91, p < 0.001). CONCLUSIONS Collectively, these findings suggest that nosocomial infections are common among patients with intracranial hemorrhage and can be predictable by considering certain risk factors. Future studies are warranted to evaluate the efficacy of implementing infection control strategies or protocols on these patients to achieve better therapeutic outcomes.
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Minaglia C, Giannotti C, Boccardi V, Mecocci P, Serafini G, Odetti P, Monacelli F. Cachexia and advanced dementia. J Cachexia Sarcopenia Muscle 2019; 10:263-277. [PMID: 30794350 PMCID: PMC6463474 DOI: 10.1002/jcsm.12380] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/20/2018] [Indexed: 12/22/2022] Open
Abstract
Cachexia is a complex metabolic process that is associated with several end-stage organ diseases. It is known to be also associated with advanced dementia, although the pathophysiologic mechanisms are still largely unknown. The present narrative review is aimed at presenting recent insights concerning the pathophysiology of weight loss and wasting syndrome in dementia, the putative mechanisms involved in the dysregulation of energy balance, and the interplay among the chronic clinical conditions of sarcopenia, malnutrition, and frailty in the elderly. We discuss the clinical implications of these new insights, with particular attention to the challenging question of nutritional needs in advanced dementia and the utility of tube feeding in order to optimize the management of end-stage dementia.
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Affiliation(s)
- Cecilia Minaglia
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy
| | - Chiara Giannotti
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy
| | - Virginia Boccardi
- Department of Medicine, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Patrizia Mecocci
- Department of Medicine, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Section of Psychiatry, I.R.C.C.S. Ospedale Policlinico San Martino, Genoa, Italy
| | - Patrizio Odetti
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fiammetta Monacelli
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Alomari M, Alomari A, Hitawala A, Khazaaleh S, Al Momani LA. Anterograde Gastroduodenal Intussusception: A Rare but Lethal Complication of Percutaneous Endoscopic Gastrostomy Tube Placement. Cureus 2019; 11:e4347. [PMID: 31187012 PMCID: PMC6541164 DOI: 10.7759/cureus.4347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) tube placement is one of the methods of providing enteral nutrition support and is often used in critically ill patients. There are several complications of PEG tube placement, including intussusception. Jejunojejunal and retrograde jejunoduodenogastric intussusception are well-documented complications of PEG tube placement. Here we describe the case of a 25-year-old female who was diagnosed with anterograde gastroduodenal intussusception with the PEG tube acting as a lead point. Our case is unique as, to the best of our knowledge, there are no documented cases of PEG tube-related anterograde gastroduodenal intussusception. The reported patient was found to have extensive gastric pneumatosis and portal venous gas concerning for acute ischemia. Such cases warrant immediate surgical intervention. However, in our case, the patient's family opted for comfort care measures.
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Affiliation(s)
| | - Ahmed Alomari
- Internal Medicine, The Hashmite University, Al-Zarqa, JOR
| | - Asif Hitawala
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland , USA
| | | | - Laith A Al Momani
- Internal Medicine, East Tennessee State University, Johnson City, USA
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Chenbhanich J, Wu A, Phupitakphol T, Atsawarungruangkit A, Treadwell T. Hospitalisation of adults with Down syndrome: lesson from a 10-year experience from a community hospital. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:266-276. [PMID: 30484927 DOI: 10.1111/jir.12572] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/16/2018] [Accepted: 11/07/2018] [Indexed: 05/26/2023]
Abstract
BACKGROUND Life expectancy of individuals with Down syndrome (DS) has improved significantly over the past decades. However, there are sparse data documenting the co-morbidities and hospitalisation of adult patients with DS in the literature. The aim of this study was to characterise the co-morbidities and pattern of hospitalisation in adult patients with DS during a 10-year period at the community hospital as well as to compare hospitalisation parameters with the general adult population during the same years. METHOD We reviewed the medical records of 81 hospitalisations from 37 patients with DS aged 21 to 68 years at Metrowest Medical Center during a 10-year period and compared with those of the general adult population during the same time. Co-morbidities were also described. RESULTS Adults with DS had a mean age at admission of 48.6 ± 8.8 years with the median length of stay of 3 days (interquartile range 4 days). Male patients were hospitalised longer than female patients (mean 5.0 vs. 2.8 days; P < 0.05), and patients who lived at home were admitted at earlier ages than those who came from residential healthcare facility (mean 41.5 vs. 52.2 years; P < 0.001). The most common cause of hospitalisation was pneumonia/aspiration syndrome (29.6%), and the most common co-morbidity was gastroesophageal reflux disease (GERD)/dysphagia (70.3%). Presence of GERD/dysphagia or seizure disorder was significantly associated with multiple admission and readmission within 1 month (P < 0.05). The mortality rate was 4.9%, and the rate of intensive care unit admission was 8.6%. CONCLUSIONS Our cohort did not show statistically significant different hospitalisation parameters such as inpatient mortality and average length of stay when compared with general adult population hospitalised at the same years. The care of adult patients with DS presents challenges in internal medicine due to its unique co-morbid profile and signifies the importance of multidisciplinary approach. In order to improve the care of this patient population, their co-morbidities, particularly GERD/dysphagia and seizure disorder, should be optimally managed and comprehensively addressed when patients are hospitalised.
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Affiliation(s)
- J Chenbhanich
- Department of Internal Medicine, Metrowest Medical Center, Framingham, MA, USA
| | - A Wu
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - T Phupitakphol
- Department of Internal Medicine, Metrowest Medical Center, Framingham, MA, USA
| | | | - T Treadwell
- Department of Internal Medicine, Metrowest Medical Center, Framingham, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston School of Medicine, Boston, MA, USA
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15
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ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2018; 38:10-47. [PMID: 30005900 DOI: 10.1016/j.clnu.2018.05.024] [Citation(s) in RCA: 642] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.
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Agudo Tabuenca A, Altemir Trallero J, Gimeno Orna JA, Ocón Bretón MJ. Mortality risk factors after percutaneous gastrostomy: Who is a good candidate? Clin Nutr 2018. [PMID: 29525511 DOI: 10.1016/j.clnu.2018.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The percutaneous gastrostomy tube (PG) is an effective and safe way for the delivery of enteral nutrition. The aim of this study was to identify predictive factors for mortality after PG placement. MATERIAL AND METHODS An observational and analytical cohort study was conducted. All endoscopic or radiological percutaneous gastrostomy tubes placed between January 2009 and July 2016 were evaluated. Mortality was the dependent variable. Initial clinical and analytical patient features and the development of complications during follow-up were recorded. Cox regression models were used to evaluate the risk of mortality associated to the studied variables. Hazard ratios with the corresponding 95% confidence intervals were retrieved from these models. RESULTS A total of 289 patients underwent PG placement (57% male). The mean age was 70.1 (SD 13.6) years. The median follow-up period was 8.7 (IQR 18) months. One hundred and seventy-four patients died during the follow-up period. The overall mortality rate was 4.8 per 100 patients-month. The highest mortality rate was during the first month after PG placement (13.2 per 100 patients-month), subsequently decreasing. Multivariate regression analysis showed that age (HR1year = 1.01; p = 0.015), Charlson comorbidity index ≥4 (HR = 1.69; p = 0.011), the presence of degenerative neurological disease (HR = 1.69; p = 0.012) or malignancy (HR = 2.02; p = 0.012) and the development of aspiration pneumonia during the follow-up period (HR = 3.29; p = 0.001) were statistically significant independent predictive risk factors associated with mortality. A model to predict survival probability prior to placing the PG was developed from the variables of the multivariate analysis. CONCLUSION Mortality after PG placement is high. Older age, higher comorbidity and the development of aspiration pneumonia are predictive factors for mortality. A more careful selection of candidates for PG placement should be done to improve the patient prognosis after the procedure.
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Affiliation(s)
- Ana Agudo Tabuenca
- Clinical University Hospital Lozano Blesa, Avenida San Juan Bosco, 15, 50009, Zaragoza, Spain.
| | | | | | - María Julia Ocón Bretón
- Clinical University Hospital Lozano Blesa, Avenida San Juan Bosco, 15, 50009, Zaragoza, Spain
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17
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Cui F, Sun L, Xiong J, Li J, Zhao Y, Huang X. Therapeutic effects of percutaneous endoscopic gastrostomy on survival in patients with amyotrophic lateral sclerosis: A meta-analysis. PLoS One 2018; 13:e0192243. [PMID: 29408898 PMCID: PMC5800689 DOI: 10.1371/journal.pone.0192243] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/18/2018] [Indexed: 12/12/2022] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is a method widely used for patients with amyotrophic lateral sclerosis (ALS); nevertheless, its effect on survival remains unclear. The purpose of this meta-analysis study was to determine the effects of PEG on survival in ALS patients. Relevant studies were retrieved from PubMed, EmBase, and the Cochrane Library databases, from inception to June 2017. Studies comparing PEG with other procedures in ALS patients were included. Odds ratios (ORs) in a random-effects model were used to assess the survival at different follow-up periods. Briefly, ten studies involving a total of 996 ALS patients were included. Summary ORs indicated that PEG administration was not associated with 30-day (OR = 1.59; 95%CI 0.93–2.71; P = 0.092), 10-month (OR = 1.25; 95%CI 0.72–2.17; P = 0.436), and 30-month (OR = 1.28; 95% CI 0.77–2.11; P = 0.338) survival rates, while they showed a beneficial effect in 20-month survival rate (OR = 1.97; 95%CI 1.21–3.21; P = 0.007). The survival rate was significantly prominent in reports published before 2005, and in studies with a retrospective design, sample size <100, mean age <60.0 years, and percentage male ≥50.0%. To sum up, these findings suggested that ALS patients administered with PEG had an increased 20-month survival rates, while there was no significant effect in 30-day, 10-month, and 30-month survival rates.
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Affiliation(s)
- Fang Cui
- Department of Neurology, Hainan Branch of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Liuqing Sun
- Department of Neurology, Hainan Branch of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Jianmei Xiong
- Department of Neurology, Hainan Branch of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Jianyong Li
- Department of Neurology, Hainan Branch of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Yangang Zhao
- Department of Neurology, Hainan Branch of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Xusheng Huang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
- * E-mail:
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18
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Wirth R. [Percutaneous endoscopic gastrostomy in geriatrics : Indications, technique and complications]. Z Gerontol Geriatr 2018; 51:237-245. [PMID: 29349584 DOI: 10.1007/s00391-017-1363-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/06/2017] [Accepted: 12/12/2017] [Indexed: 11/26/2022]
Abstract
The technique of percutaneous endoscopic gastrostomy (PEG) was introduced in 1979 as a semi-invasive approach for children with the need for a gastric fistula in order to avoid an operative intervention. The suture pull-through method was rapidly established and is now omnipresent. Because scientific evidence is broadly missing, there is some uncertainty about the indications in geriatric medicine. Guidelines do not recommend the insertion of a PEG in patients with severe dementia and malnutrition. Tube feeding is mainly recommended as a temporary method for patients who cannot take oral nutrition for more than 3 days or for whom the energy intake for more than 10 days presumably covers less than 50% of their needs, assuming that the overall prognosis is reasonable. Insertion of a PEG is only recommended if artificial nutrition is expected to be necessary for more than 3-4 weeks or if a nasogastric tube is not tolerated.
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Affiliation(s)
- Rainer Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.
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19
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Wong A, Goh G, Banks MD, Bauer JD. A systematic review of the cost and economic outcomes of home enteral nutrition. Clin Nutr 2017; 37:429-442. [PMID: 28679469 DOI: 10.1016/j.clnu.2017.06.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/08/2017] [Accepted: 06/14/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Studies are lacking in the health economic implications of home enteral nutrition (HEN) in home-residing and long-term care/institutionalized patients. The aims of this review were to determine the total costs, the cost-effectiveness and other economic outcomes for HEN. DESIGN A systematic search of randomized trials and observational studies available from January 2000 to April 2016 was performed using standard literature and electronic databases. Inclusion criteria were adults receiving HEN with economic outcomes in the long-term care or home settings. There was no restriction to the control groups used in the studies. RESULTS A total of 10 studies met the inclusion criteria. The majority of the studies were not specifically designed for economic evaluation. Cost per QALY was lower in residents residing in home compared to long-term care facilities, and HEN appeared to be cost-effective for those with pressure ulcers. Higher costs were incurred for patients with dementia on HEN. Lower hospitalization costs and infection rates were reported for patients who switched to commercial feeds from blenderized food. The availability of nutritional support teams may decrease overall costs but these studies were of poor study quality. CONCLUSIONS The lack of good quality economic evaluation studies affected the ability to conclude the overall cost-effectiveness of HEN. There is a trend for cost-saving and improved clinical outcomes in some populations. HEN is unlikely beneficial for patients with dementia. The availability of a nutrition support team may lead to cost savings and improved clinical outcomes for HEN.
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Affiliation(s)
- A Wong
- Dietetic and Food Services, Changi General Hospital, Singapore; School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, Australia.
| | - G Goh
- Health Services Research, Eastern Health Alliance, Singapore
| | - M D Banks
- Royal Brisbane and Women's Hospital, Department of Nutrition and Dietetics, Queensland, Australia
| | - J D Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, Australia
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20
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PEG Insertion in Patients With Dementia Does Not Improve Nutritional Status and Has Worse Outcomes as Compared With PEG Insertion for Other Indications. J Clin Gastroenterol 2017; 51:417-420. [PMID: 27505401 DOI: 10.1097/mcg.0000000000000624] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) tubes are commonly utilized as a method of enteral feeding in patients unable to obtain adequate oral nutrition. Although some studies have shown improved mortality in select populations, the safety and effectiveness of PEG insertion in patients with dementia compared with those with other neurological diseases or head and neck malignancy remains less well defined. OBJECTIVE To evaluate the nutritional effectiveness, rate of rehospitalization, and risk of mortality among patients with dementia compared with patients with other neurological diseases or head and neck cancers who undergo PEG placement. MATERIALS AND METHODS We conducted a retrospective analysis from a prospective database of patients who underwent PEG placement at an academic tertiary center between 2008 and 2013. The following data were collected: indication for PEG, patient demographics, biochemical markers of nutritional status rehospitalization, and survival rates. RESULTS During the study period, 392 patients underwent PEG tube placement. Indications for PEG were dementia (N=165, group A), cerebrovascular accident (N=124, group B), and other indications such as oropharyngeal cancers and motor neuron disease (N=103, group C). The mean follow-up time after PEG was 18 months (range, 3 to 36 mo). No differences in baseline demographics were noted. PEG insertion in the dementia (group A) neither reduced the rehospitalization rate 6 months' postprocedure compared with groups B and C (2.45 vs. 1.86 and 1.65, respectively; P=0.05), nor reduced the mortality rate within the first year post-PEG placement (75% vs. 58% and 38% for groups A, B, and C, respectively, P=0.001), as well, it did not improve survival at 1 month after the procedure (15% vs. 3.26% and 7.76%, for groups A, B, C, respectively, P<0.01). The presence of dementia was also associated with shorter mean time to death (7.2 vs. 8.85 and 8 mo for groups A, B, C, respectively, P<0.05). The rate of improvement of the nutritional biomarker albumin was lower in the dementia group [3.1. to 2.9 vs. 3.2 to 3.3 and 3 to 3.3 g/dL for groups A, B, and C, respectively (P<0.02)]. Multivariate regression analysis showed that the presence of dementia was an independent predictor for mortality rate within the first year and 1-month mortality rate in patients undergoing PEG insertion with odds ratio 3.22 (95% confidence interval, 1.52-4.32) and odds ratio 2.52 (95% confidence interval, 1.22-3.67). CONCLUSIONS PEG insertion in patients with dementia neither improve both short-term and long-term mortality nor rehospitalization rate as compared with patients who underwent PEG placement for alternate indications such as other neurological diseases or head and neck malignancy and even was associated with shorter time to death. Furthermore, PEG insertion in patients with dementia did not improve albumin. Therefore, careful selection of patients with dementia is warranted before PEG placement weighing the risks and benefits on a personalized basis.
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21
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Tomioka H, Yamashita S, Mamesaya N, Kaneko M. Percutaneous endoscopic gastrostomy for aspiration pneumonia: A 10-year single-center experience. Respir Investig 2017; 55:203-211. [PMID: 28427747 DOI: 10.1016/j.resinv.2016.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/03/2016] [Accepted: 12/21/2016] [Indexed: 11/13/2022]
Abstract
BACKGROUND The significance of percutaneous endoscopic gastrostomy (PEG) in patients with aspiration pneumonia is unknown. The purpose of this study was to evaluate the clinical characteristics and outcomes of aspiration pneumonia patients who underwent PEG. METHODS A retrospective cohort study of consecutive patients hospitalized with pneumonia who underwent PEG from 2005 to 2014. RESULTS Of 2281 cases of pneumonia, 92 patients with aspiration pneumonia underwent PEG during their hospital stay. The rate of PEG insertion significantly decreased after 2011, when Japanese therapeutic guidelines for pneumonia in the elderly were published (5.9% vs. 1.6% before and after guideline publication, respectively; p<0.01). The study population was male dominant (63%), with a mean age of 80.7 years. They had several risk factors for aspiration pneumonia, such as dementia (63.0%), cerebrovascular disorders (37.0%), and neurologic diseases (28.3%). Survival after PEG was 88.0% at day 30, 84.3% at 3 months, 73.8% at 6 months, and 61.1% at 1 year with a median survival of 751 days. Pneumonia was the most common cause of death during the follow-up period (22 of 51 patients, 43.1%). Cox proportional hazard model showed that independent predictors of mortality were older age, male gender, comorbidity of heart failure, and lower serum albumin values before PEG. CONCLUSIONS The rate of PEG placement is decreasing after the Japanese guidelines were published in 2011. While the overall median survival was approximately 2 years, the most common cause of death was pneumonia and mortality was associated with some significant factors.
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Affiliation(s)
- Hiromi Tomioka
- Department of Respiratory Medicine, Kobe City Medical Center West Hospital, 4, 2-chome, Ichibancho, Nagata-ku, Kobe 653-0013, Japan.
| | - Shyuji Yamashita
- Department of Respiratory Medicine, Kobe City Medical Center West Hospital, 4, 2-chome, Ichibancho, Nagata-ku, Kobe 653-0013, Japan.
| | - Nobuaki Mamesaya
- Department of Respiratory Medicine, Kobe City Medical Center West Hospital, 4, 2-chome, Ichibancho, Nagata-ku, Kobe 653-0013, Japan.
| | - Masahiro Kaneko
- Department of Respiratory Medicine, Kobe City Medical Center West Hospital, 4, 2-chome, Ichibancho, Nagata-ku, Kobe 653-0013, Japan.
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Affiliation(s)
- Susan W Tolle
- From the Division of General Internal Medicine and Geriatrics and the Center for Ethics in Health Care, Oregon Health and Science University, Portland (S.W.T.); and the Division of Gerontology and Geriatric Medicine and Cambia Palliative Care Center of Excellence, University of Washington, Seattle (J.M.T.)
| | - Joan M Teno
- From the Division of General Internal Medicine and Geriatrics and the Center for Ethics in Health Care, Oregon Health and Science University, Portland (S.W.T.); and the Division of Gerontology and Geriatric Medicine and Cambia Palliative Care Center of Excellence, University of Washington, Seattle (J.M.T.)
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23
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Muratori R, Lisotti A, Fusaroli P, Caponi A, Gibiino G, Eusebi LH, Azzaroli F, Brighi N, Altimari G, Bazzoli F. Severe hypernatremia as a predictor of mortality after percutaneous endoscopic gastrostomy (PEG) placement. Dig Liver Dis 2017; 49:181-187. [PMID: 27856199 DOI: 10.1016/j.dld.2016.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/10/2016] [Accepted: 10/23/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy is the preferred option for providing enteral nutrition, allowing for an improvement in survival and quality of life. AIM To evaluate risk factors for early and delayed mortality after gastrostomy placement. METHODS A single-center retrospective analysis of a prospectively-collected database including all patients undergoing gastrostomy placement for enteral nutrition was performed. Two operators performed all the procedures according to the most recent guidelines. RESULTS Analysis included data on 438 patients [178 male; 80.5 (72-86) year-old]. Indications for PEG were stroke (34.0%), dementia (31.3%), neurodegenerative disorders (18.5%), coma (9.1%) and cancer (7.1%). No periprocedural adverse events was observed. Mean survival was 14.6±3.4months; 1-month and 3-month mortality rates were 4.0% and 8.1%, respectively. Severe hypernatremia (≥150mmol/L) was independently related to 1-month mortality (odds ratio 25.4; P<0.0001), while C-reactive protein level>4.3mg/dL was independently related to 3-month mortality (odds ratio 5.3; P=0.003). Kaplan-Meier and Cox-regression analysis identified male gender (hazard ratio 2.32; P=0.0002), severe hypernatremia (hazard ratio 4.3; P<0.0001), C-reactive protein>4.3mg/dL (hazard ratio 3.5; P=0.0014), leukocytosis (hazard ratio 1.97; P=0.0036) and presence of underlying malignancy (hazard ratio 2.4; P=0.0013) as independent risk factors for long-term mortality. DISCUSSION Presence of severe hypernatremia and increased C-reactive protein levels were strongly correlated with early and delayed mortality in our population. Studies are necessary to understand whether correcting underlying dehydration and inflammation further improves patients' outcomes.
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Affiliation(s)
- Rosangela Muratori
- S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy.
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy
| | - Alessandra Caponi
- S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy
| | - Giulia Gibiino
- S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy
| | - Leonardo Henry Eusebi
- S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy
| | - Francesco Azzaroli
- S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy
| | - Nicole Brighi
- S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy
| | | | - Franco Bazzoli
- S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy
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Wirth R, Diekmann R, Fleiter O, Fricke L, Kreilkamp A, Modreker MK, Marburger C, Nels S, Schaefer R, Willschrei HP, Volkert D. [Refeeding syndrome in geriatric patients : A frequently overlooked complication]. Z Gerontol Geriatr 2017; 51:34-40. [PMID: 28070675 DOI: 10.1007/s00391-016-1160-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/19/2016] [Accepted: 11/11/2016] [Indexed: 11/24/2022]
Abstract
The refeeding syndrome is a life-threatening complication that can occur after initiation of a nutrition therapy in malnourished patients. If the risk factors and pathophysiology are known, the refeeding syndrome can effectively be prevented and treated, if recognized early. A slow increase of food intake and the close monitoring of serum electrolyte levels play an important role. Because the refeeding syndrome is not well known and the symptoms may vary extremely, this complication is poorly recognized, especially against the background of geriatric multimorbidity. This overview is intended to increase the awareness of the refeeding syndrome in the risk group of geriatric patients.
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Affiliation(s)
- Rainer Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland. .,Lehrstuhl für Geriatrie, Ruhr-Universität Bochum, Bochum, Deutschland.
| | - Rebecca Diekmann
- Universitätsklinik für Geriatrie, Klinikum Oldenburg, Oldenburg, Deutschland
| | - Olga Fleiter
- Klinik für Innere Medizin, Franziskus Hospital Bielefeld, Bielefeld, Deutschland
| | - Leonhardt Fricke
- Klinik für Geriatrie, St. Katharinen-Krankenhaus, Frankfurt, Deutschland
| | - Annika Kreilkamp
- Lehrstuhl für Geriatrie, Ruhr-Universität Bochum, Bochum, Deutschland
| | | | - Christian Marburger
- Klinik für Geriatrische Rehabilitation, Klinikum Christophsbad, Göppingen, Deutschland
| | - Stefan Nels
- Klinik für Geriatrie, Hochtaunus Kliniken, Bad Homburg, Deutschland
| | - Rolf Schaefer
- Klinik für Geriatrie, Marien-Krankenhaus Bergisch-Gladbach, Bergisch-Gladbach, Deutschland
| | - Heinz-Peter Willschrei
- Klinik für Innere Medizin/Geriatrie, Malteser Krankenhaus St. Josefshospital, Krefeld, Deutschland
| | - Dorothee Volkert
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
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Kalkan Ç, Kartal AÇ, Karakaya F, Tüzün A, Soykan I. Utility of Three Prognostic Risk Scores in Predicting Outcomes in Elderly Non-Malignant Patients after Percutaneous Gastrostomy. J Nutr Health Aging 2017; 21:1344-1348. [PMID: 29188899 DOI: 10.1007/s12603-016-0853-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND/OBJECTIVES Percutaneous endoscopic gastrostomy is a method of providing enteral feeding to patients who cannot take adequate oral nutrition. The aims of this study were to determine the performance of malnutrition and mortality scoring systems for predicting short and long-term mortality in elderly patients who had undergone gastrostomy procedure due to non-malignant conditions. DESIGN Retrospective cohort study. SETTING University hospital in Turkey. PARTICIPANTS 155 individuals aged 65 and older principally hospitalized for non-malignant diseases and require percutaneous endoscopic gastrostomy. MEASUREMENTS "Geriatric Nutritional Risk Index", "Malnutrition Universal Screening Tool" (MUST) and "Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity" (P-POSSUM) scores were calculated. The ability of these scores to predict mortality was determined. RESULTS The mean survival period was 9.59±6.0 months and mortality rate was 80.6%. The performance of "Geriatric Nutritional Risk Index" was superior to MUST and P-POSSUM in predicting long-term survival of gastrostomy patients; 94.1% of patients were alive with a cut-off value of 90 for "Geriatric Nutritional Risk Index" (sensitivity: 92% CI 85.9-95.6 and specificity: 90% CI 74.3-96.5). Survival analysis showed that patients (n=7) with a "Geriatric Nutritional Risk Index" score of > 98 before the gastrostomy had the longest survival time, while patients (n=102) with a "Geriatric Nutritional Risk Index" score of < 82 had the worst outcome. CONCLUSIONS A scoring system such as "Geriatric Nutritional Risk Index" should be considered as a risk scoring system for predicting early and late mortality at gastrostomy and also assist in making decisions such as timing of gastrostomy procedure.
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Affiliation(s)
- Ç Kalkan
- Irfan Soykan, Ankara University Medical School, Gastroenterology, Sihhiye, 06100, Ankara, Turkey, Tel: +90 312 5082759, Fax: +90 312 3103446, e-mail:
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Kara O, Kizilarslanoglu MC, Canbaz B, Arik G, Varan HD, Kuyumcu ME, Kilic MK, Sumer F, Yesil Y, Yavuz BB, Cankurtaran M, Ozturk O, Kav T, Halil M. Survival After Percutaneous Endoscopic Gastrostomy in Older Adults With Neurologic Disorders. Nutr Clin Pract 2016; 31:799-804. [DOI: 10.1177/0884533616648132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Ozgur Kara
- Hacettepe University Medical School, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey
| | | | - Busra Canbaz
- Hacettepe University Medical School, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey
| | - Gunes Arik
- Hacettepe University Medical School, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey
| | - Hacer Dogan Varan
- Hacettepe University Medical School, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey
| | - Mehmet Emin Kuyumcu
- Hacettepe University Medical School, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey
| | - Mustafa Kemal Kilic
- Hacettepe University Medical School, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey
| | - Fatih Sumer
- Hacettepe University Medical School, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey
| | - Yusuf Yesil
- Hacettepe University Medical School, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey
| | - Burcu Balam Yavuz
- Hacettepe University Medical School, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- Hacettepe University Medical School, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey
| | - Omer Ozturk
- Hacettepe University Medical School, Department of Internal Medicine, Division of Gastroenterology, Ankara, Turkey
| | - Taylan Kav
- Hacettepe University Medical School, Department of Internal Medicine, Division of Gastroenterology, Ankara, Turkey
| | - Meltem Halil
- Hacettepe University Medical School, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey
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Australian and New Zealand Society for Geriatric Medicine Position Statement Abstract: Undernutrition and the older person. Australas J Ageing 2016; 36:75. [DOI: 10.1111/ajag.12344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Jiang YL, Ruberu N, Liu XS, Xu YH, Zhang ST, Chan DK. Mortality trend and predictors of mortality in dysphagic stroke patients postpercutaneous endoscopic gastrostomy. Chin Med J (Engl) 2016; 128:1331-5. [PMID: 25963353 PMCID: PMC4830312 DOI: 10.4103/0366-6999.156777] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Percutaneous endoscopic gastrostomy (PEG) feeding is widely used in stroke patients suffering from persistent dysphagia; however, predicting the risks and benefits of PEG insertion in the individual patient is difficult. The aim of our study was to investigate if candidate risk factors could predict short-term mortality risk in poststroke patients who had PEG tube insertion for persistent dysphagia. Methods: This was a retrospective study of 3504 consecutive stroke patients admitted to two metropolitan hospitals during the period January 2005 to December 2013 and who also underwent PEG insertion for feeding due to persistent dysphagia. Results: A total of 102 patients were included in the study. There were 22 deaths in 6 months after insertion of PEG tubes and 20 deaths of those occurred within 3 months post PEG. Those who survived beyond 6 months showed significantly lower mean age (75.9 ± 9.0 years vs. 83.0 ± 4.9 years, P < 0.001), a lower mean American Society of Anesthesia (ASA) score (3.04 ± 0.63 vs. 3.64 ± 0.58, P < 0.001) compared to nonsurvivors. In multiple Logistic, age (P = 0.004, odds ratio [OR] = 1.144; 95% confidence interval [CI]: 1.044–1.255); ASA (P = 0.002, OR = 5.065; 95% CI: 1.815–14.133) and albumin level pre-PEG insertion (P = 0.033, OR = 0.869; 95% CI: 0.764–0.988) were the independent determinants of mortality respectively. Conclusions: We propose that age, ASA score and albumin level pre-PEG insertion to be included as factors to assist in the selection of patients who are likely to survive more than 3 months post PEG insertion.
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Affiliation(s)
| | | | | | | | - Shu-Tian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Daniel Ky Chan
- Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia
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Tamiya H, Yasunaga H, Matusi H, Fushimi K, Akishita M, Ogawa S. Comparison of short-term mortality and morbidity between parenteral and enteral nutrition for adults without cancer: a propensity-matched analysis using a national inpatient database. Am J Clin Nutr 2015; 102:1222-8. [PMID: 26447149 DOI: 10.3945/ajcn.115.111831] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/10/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Proper artificial nutrition for patients who are unable to eat normally is an ongoing, unresolved concern in geriatric medicine and home medical care. Controversy surrounds prognostic differences between parenteral and enteral nutrition, 2 methods for artificial nutrition. OBJECTIVES Short-term outcomes of parenteral and enteral nutrition for patients who are unable to eat normally were compared and analyzed. DESIGN Data were acquired from patients selected from a national inpatient database covering 1057 hospitals in Japan. Participants had received artificial nutrition between April 2012 and March 2013, were aged ≥20 y, and did not have cancer. They were separated into 2 groups: those who received parenteral nutrition and those who received enteral nutrition. We performed one-to-one propensity score matching between the groups. The primary outcome measurements were mortality rates at 30 and 90 d after the start of the procedure. The secondary outcomes were postprocedural complications, pneumonia, and sepsis. We analyzed survival length of stay after the procedure with the use of a Cox proportional hazards model. RESULTS There were 3750 patients in the parenteral group and 22,166 patients in the enteral group. Propensity score matching created 2912 pairs in the 2 groups. Patients with a similar propensity score (probability of being assigned to the enteral group) calculated from the baseline condition were matched. Mortality rates at 30 and 90 d after start of treatment were 7.6% and 5.7% (P = 0.003) and 12.3% and 9.9% (P = 0.002) in the parenteral and enteral groups, respectively. In Cox regression analysis, the HR for the enteral group relative to the parenteral group was 0.62 (95% CI: 0.54, 0.71; P < 0.001). The incidences of postprocedural pneumonia and sepsis were 11.9% and 15.5% (P < 0.001) and 4.4% and 3.7% (P = 0.164) for the parenteral and enteral groups, respectively. CONCLUSION The present analysis showed the better survival rate with enteral compared with parenteral nutrition for adults who were not suffering from cancer. This trial was registered at clinicaltrials.gov as NCT02512224.
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Affiliation(s)
- Hiroyuki Tamiya
- Departments of Geriatric Medicine, Graduate School of Medicine, and
| | - Hideo Yasunaga
- Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; and
| | - Hiroki Matusi
- Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; and
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | | | - Sumito Ogawa
- Departments of Geriatric Medicine, Graduate School of Medicine, and
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Holt DQ, McDonald JF, Murray ML, Hair C, Devonshire DA, Strauss BJ, Moore GT. Clinical selection criteria can predict futile intervention in patients referred for percutaneous endoscopic gastrostomy insertion. Intern Med J 2015; 45:648-52. [DOI: 10.1111/imj.12705] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/28/2015] [Indexed: 01/12/2023]
Affiliation(s)
- D. Q. Holt
- Gastroenterology and Hepatology Unit; Monash Health; Melbourne Australia
- Clinical Nutrition and Metabolism Unit; Monash Health; Melbourne Australia
- Department of Medicine, School of Clinical Sciences; Monash University; Melbourne Australia
| | - J. F. McDonald
- Clinical Nutrition and Metabolism Unit; Monash Health; Melbourne Australia
- PEG Outreach Service; Monash Health; Melbourne Australia
| | - M. L. Murray
- Clinical Nutrition and Metabolism Unit; Monash Health; Melbourne Australia
- PEG Outreach Service; Monash Health; Melbourne Australia
| | - C. Hair
- School of Medicine; Deakin University; Geelong Victoria Australia
| | - D. A. Devonshire
- Gastroenterology and Hepatology Unit; Monash Health; Melbourne Australia
| | - B. J. Strauss
- Clinical Nutrition and Metabolism Unit; Monash Health; Melbourne Australia
- Department of Medicine, School of Clinical Sciences; Monash University; Melbourne Australia
| | - G. T. Moore
- Gastroenterology and Hepatology Unit; Monash Health; Melbourne Australia
- Department of Medicine, School of Clinical Sciences; Monash University; Melbourne Australia
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Oh DJ, Kim B, Lee JK, Kang HW, Kim JH, Lim YJ, Koh MS, Lee JH. Can percutaneous endoscopic gastrostomy be carried out safely in the elderly? Geriatr Gerontol Int 2015; 16:481-5. [DOI: 10.1111/ggi.12495] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Dong Jun Oh
- Department of Internal Medicine; Dongguk University Ilsan Hospital; Dongguk University; College of Medicine; Goyang Korea
| | - Bernice Kim
- Department of Internal Medicine; Dongguk University Ilsan Hospital; Dongguk University; College of Medicine; Goyang Korea
| | - Jun Kyu Lee
- Department of Internal Medicine; Dongguk University Ilsan Hospital; Dongguk University; College of Medicine; Goyang Korea
| | - Hyoun Woo Kang
- Department of Internal Medicine; Dongguk University Ilsan Hospital; Dongguk University; College of Medicine; Goyang Korea
| | - Jae Hak Kim
- Department of Internal Medicine; Dongguk University Ilsan Hospital; Dongguk University; College of Medicine; Goyang Korea
| | - Yun Jeong Lim
- Department of Internal Medicine; Dongguk University Ilsan Hospital; Dongguk University; College of Medicine; Goyang Korea
| | - Moon-Soo Koh
- Department of Internal Medicine; Dongguk University Ilsan Hospital; Dongguk University; College of Medicine; Goyang Korea
| | - Jin Ho Lee
- Department of Internal Medicine; Dongguk University Ilsan Hospital; Dongguk University; College of Medicine; Goyang Korea
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Bentur N, Sternberg S, Shuldiner J, Dwolatzky T. Feeding tubes for older people with advanced dementia living in the community in Israel. Am J Alzheimers Dis Other Demen 2015; 30:165-72. [PMID: 24963078 PMCID: PMC10852585 DOI: 10.1177/1533317514539726] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
BACKGROUND Feeding tubes to address eating problems of older people with advanced dementia (OPAD) has been studied primarily in nursing homes. OBJECTIVES To examine the prevalence of feeding tube use among OPAD living in the community; to evaluate the characteristics, quality of care, and the burden on caregivers. METHODS A cross-sectional survey of 117 caregivers of OPAD living in the community. RESULTS Of 117 patients, 26% had feeding tubes. Compared to nonusers, feeding tube users had more use of restraints, greater problems with swallowing, more emergency room visits, and were more likely to have a legal guardian. In addition, caregivers of feeding tube users were older and reported very heavy burden of care. Half of the caregivers reported that the medical team consulted them before insertion of the feeding tube. CONCLUSION Feeding tube use in OPAD in the community is associated with negative outcomes and increased caregiver burden.
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Affiliation(s)
- Netta Bentur
- Aging Department, Myers-JDC-Brookdale Institute, Jerusalem, Israel
| | - Shelley Sternberg
- Division of Public Health, Maccabi Healthcare Services, Jerusalem, Israel Aging Department, Shaarei Zedek Medical Center Memory Clinic, Jerusalem, Israel
| | | | - Tzvi Dwolatzky
- Faculty of Health Sciences, Mental Health Center, and Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beersheva, Israel Aging Department, Rambam Health Care Campus, Haifa, Israel
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Govednik C, Cover J, Regner JL. Preventing retrograde jejunoduodenogastric intussusception as a complication of a long-term indwelling gastrostomy tube. Proc AMIA Symp 2015; 28:34-7. [PMID: 25552793 PMCID: PMC4264705 DOI: 10.1080/08998280.2015.11929179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Gastrostomy tubes are frequently used to provide enteral access in a variety of patient populations. Long-term complications are usually minor and include ulceration of the surrounding skin, clogging or dislodgment of the feeding tube, and superficial abscess; severe long-term complications are rare. Here we report a case of a life-threatening complication from an indwelling gastrostomy tube, specifically retrograde jejunoduodenogastric intussusception. Computed tomography and intraoperative images, as well as a review of literature, provide a detailed picture for diagnosis and treatment. Although feeding tubes are now routine and associated with low morbidity, physicians should remain aware of this potentially lethal complication in order to minimize the increased morbidity and mortality from intussusception and subsequent bowel ischemia.
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Affiliation(s)
- Cara Govednik
- Department of Surgery, Scott & White Healthcare and Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Joylin Cover
- Department of Surgery, Scott & White Healthcare and Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Justin L Regner
- Department of Surgery, Scott & White Healthcare and Texas A&M Health Science Center College of Medicine, Temple, Texas
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Abraham RR, Girotra M, Wei JY, Azhar G. Is short-term percutaneous endoscopic gastrostomy tube placement beneficial in acutely ill cognitively intact elderly patients? A proposed decision-making algorithm. Geriatr Gerontol Int 2014; 15:572-8. [PMID: 25109444 DOI: 10.1111/ggi.12316] [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: 04/15/2014] [Indexed: 11/27/2022]
Abstract
AIM Percutaneous endoscopic gastrostomy (PEG) tube is an important method of enteral feeding for patients who require temporary or long-term artificial nutritional support to prevent or correct disease-related malnutrition. However, there is paucity of data on the utility of short-term PEG tube placements in acute illnesses in cognitively intact older adults. METHODS We present a series of seven, cognitively intact patients (age range 72-93 years), who had PEG tubes placed for short periods. These patients were diagnosed with "failure to thrive" and were managed by placing a PEG tube temporarily for nutritional management. None of these patients had terminal illness or hospice eligibility, and all of the patients were community dwellers. RESULTS All of the elderly patients experienced good outcomes in terms of their functional status and nutritional support. CONCLUSIONS Our series clearly supports the notion that short-term PEG tube placement in cognitively intact elderly patients could be a successful strategy to support them during an episode of acute illness, and to improve their nutritional deficits and survival.
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Affiliation(s)
- Rtika R Abraham
- Department of Geriatrics and Reynolds Institute of Aging, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Schneider AS, Schettler A, Markowski A, Luettig B, Kaufmann B, Klamt S, Lenzen H, Momma M, Seipt C, Lankisch T, Negm AA. Complication and mortality rate after percutaneous endoscopic gastrostomy are low and indication-dependent. Scand J Gastroenterol 2014; 49:891-8. [PMID: 24896841 DOI: 10.3109/00365521.2014.916343] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Percutaneous endoscopic gastrostomy (PEG) is often used for the feeding of patients with malnutrition due to dysphagia, and despite more than 30 years experience, numerous questions on its benefit remain. This was a prospective observational study to assess the safety of PEG. MATERIAL AND METHODS One hundred and nineteen patients mean age 63 years (21-91 years) who were admitted to the Hannover Medical School between November 2010 and March 2012 and had an indication for PEG according to the German guidelines were included. Primary endpoints were the following: reason for indication, date of in-hospital mortality after PEG insertion, death within 3 months after PEG placement, and complications. RESULTS Most patients (54.6%) received PEG for dysphagia caused by tumors and second (29.4%) for neurologic diseases with a minor proportion of dementia (3%). About 73% of our patients had no complications at all and only 10% suffered severe effects. We saw only 1 case of aspiration, which did not lead to pneumonia. The 30-day mortality was 10%, and no patient died as a result of the PEG procedure. Significantly more patients with neurologic disorders died within 24 weeks of PEG placement than tumor patients (60% versus 27.7%, respectively, p = 0.002, n = 100). CONCLUSION It is important to select patients receiving PEG very carefully. The patients' indications, their primary disease, and their capability for mental cooperation are essential. If these aspects are taken into account, PEG is a safe method with few mainly mild complications.
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Affiliation(s)
- Andrea S Schneider
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School , Hannover , Germany
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Stephens CE, Sackett N, Govindarajan P, Lee SJ. Emergency department visits and hospitalizations by tube-fed nursing home residents with varying degrees of cognitive impairment: a national study. BMC Geriatr 2014; 14:35. [PMID: 24650076 PMCID: PMC3994482 DOI: 10.1186/1471-2318-14-35] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 03/07/2014] [Indexed: 11/24/2022] Open
Abstract
Background Numerous studies indicate that the use of feeding tubes (FT) in persons with advanced cognitive impairment (CI) does not improve clinical outcomes or survival, and results in higher rates of hospitalization and emergency department (ED) visits. It is not clear, however, whether such risk varies by resident level of CI and whether these ED visits and hospitalizations are potentially preventable. The objective of this study was to determine the rates of ED visits, hospitalizations and potentially preventable ambulatory care sensitive (ACS) ED visits and ACS hospitalizations for long-stay NH residents with FTs at differing levels of CI. Methods We linked Centers for Medicare and Medicaid Services inpatient & outpatient administrative claims and beneficiary eligibility data with Minimum Data Set (MDS) resident assessment data for nursing home residents with feeding tubes in a 5% random sample of Medicare beneficiaries residing in US nursing facilities in 2006 (n = 3479). Severity of CI was measured using the Cognitive Performance Scale (CPS) and categorized into 4 groups: None/Mild (CPS = 0-1, MMSE = 22-25), Moderate (CPS = 2-3, MMSE = 15-19), Severe (CPS = 4-5, MMSE = 5-7) and Very Severe (CPS = 6, MMSE = 0-4). ED visits, hospitalizations, ACS ED visits and ACS hospitalizations were ascertained from inpatient and outpatient administrative claims. We estimated the risk ratio of each outcome by CI level using over-dispersed Poisson models accounting for potential confounding factors. Results Twenty-nine percent of our cohort was considered “comatose” and “without any discernible consciousness”, suggesting that over 20,000 NH residents in the US with feeding tubes are non-interactive. Approximately 25% of NH residents with FTs required an ED visit or hospitalization, with 44% of hospitalizations and 24% of ED visits being potentially preventable or for an ACS condition. Severity of CI had a significant effect on rates of ACS ED visits, but little effect on ACS hospitalizations. Conclusions ED visits and hospitalizations are common in cognitively impaired tube-fed nursing home residents and a substantial proportion of ED visits and hospitalizations are potentially preventable due to ACS conditions.
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Affiliation(s)
- Caroline E Stephens
- Department of Community Health Systems, University of California San Francisco, 2 Koret Way, #N531E, San Francisco, CA 94143-0608, USA.
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Lee SP, Lee KN, Lee OY, Lee HL, Jun DW, Yoon BC, Choi HS, Kim SH. Risk factors for complications of percutaneous endoscopic gastrostomy. Dig Dis Sci 2014; 59:117-25. [PMID: 24142070 DOI: 10.1007/s10620-013-2891-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 09/14/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is a commonly performed procedure for patients with severe dysphagia leading to malnutrition. Improved knowledge of risk factors for PEG-related complications might decrease patient discomfort and healthcare costs. AIM The aim of the present study was to investigate factors associated with complications after PEG. METHODS A retrospective review was performed for all patients referred for PEG placement from December 2002 to December 2012 in single-tertiary care center. PEG-related complications and risk factors were evaluated through chart reviews, endoscopic reports, and endoscopic and radiologic images. RESULTS Among a total of 245 consecutive individuals (146 male, mean age 59.2 ± 12.6 years) enrolled, 43 major complications had developed. Multivariate analysis revealed that patients with an internal bolster of a PEG tube in the upper body of stomach were at significant risk for early [OR 6.127 (95 % CI 1.447-26.046)] and late complications [OR 6.710 (95 % CI 1.692-26.603)]. Abnormal leukocyte counts [OR 3.198 (95 % CI 1.174-8.716)], stroke as an indication for PEG [OR 3.047 (95 % CI 1.174-8.882)], and PEG tube placement by an inexperienced endoscopist [OR 3.401 (95 % CI 1.073-10.779)] were significantly associated with early complications. CONCLUSIONS A PEG tube should not be inserted into the upper body of stomach to reduce complication risk, and PEG procedures should be performed by skilled endoscopists to prevent early complications. An abnormal leukocyte count can be a predictor of early complication, and care is needed when PEG is performed for patients with stroke.
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Affiliation(s)
- Sang Pyo Lee
- Department of Internal Medicine, Digestive Disease Centre, Konkuk University School of Medicine, Seoul, Korea
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Igawa Y, Matsubara I. [Age at the time of gastrostomy placement as a prognostic factor in long-term hospitalized patients]. Nihon Ronen Igakkai Zasshi 2013; 50:536-41. [PMID: 24047670 DOI: 10.3143/geriatrics.50.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the influence of age at the time of gastrostomy placement as a prognostic factor and examine the survival rate in long-term hospitalized patients with gastrostomy. METHODS The subjects were 408 inpatients with gastrostomy admitted to our hospital between December 2005 and March 2012. All inpatients, including the present subjects, received oral care in the form of attendant care by nurses or caregivers. First, the subjects were divided into two groups according to sex. Second, the subjects were divided into four groups according to the age at the time of gastrostomy placement: the sixties group (60-69 years), seventies group (70-79 years), eighties group (80-89 years), and nineties group (90-99 years). Each survival curve was drawn using the Kaplan-Meier method, and the log-rank tests were used for statistical analysis. The Cox proportional hazard models were used to calculate hazard ratios. RESULTS The overall survival rates at one year and five years after gastrostomy placement were 75.4% and 23.2%, respectively. The median survival period was 32.2 months. A significantly better prognosis was observed in women than in men; the age-adjusted hazard ratio was 1.748 (95% CI, 1.364-2.242) for men. The eighties and nineties groups exhibited significantly poorer prognoses than that of the sixties group (p<0.008); the sex-adjusted hazard ratios were 2.173 (95% CI, 1.341-3.521) and 3.071 (95% CI, 1.627-5.797), respectively. CONCLUSIONS These results suggest that oral care, even after gastrostomy placement, can improve the prognosis in patients with gastrostomy. Physicians should therefore be cautious when recommending gastrostomy placement for patients aged>80 years.
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Affiliation(s)
- Yukimasa Igawa
- Department of Internal Medicine and Rehabilitation, Aizen Hospital
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Chandrasekhara V, Early DS, Acosta RD, Chathadi KV, Decker GA, Evans JA, Fanelli RD, Fisher DA, Foley KQ, Fonkalsrud L, Hwang JH, Jue T, Khashab MA, Lightdale JR, Muthusamy VR, Pasha SF, Saltzman JR, Sharaf R, Shergill AK, Cash BD. Modifications in endoscopic practice for the elderly. Gastrointest Endosc 2013; 78:1-7. [PMID: 23664042 DOI: 10.1016/j.gie.2013.04.161] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 12/12/2022]
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Cai S, Gozalo PL, Mitchell SL, Kuo S, Bynum JPW, Mor V, Teno JM. Do patients with advanced cognitive impairment admitted to hospitals with higher rates of feeding tube insertion have improved survival? J Pain Symptom Manage 2013; 45:524-33. [PMID: 22871537 PMCID: PMC3594461 DOI: 10.1016/j.jpainsymman.2012.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 02/22/2012] [Accepted: 02/23/2012] [Indexed: 11/30/2022]
Abstract
CONTEXT Research is conflicting on whether receiving medical care at a hospital with more aggressive treatment patterns improves survival. OBJECTIVES The aim of this study was to examine whether nursing home residents admitted to hospitals with more aggressive patterns of feeding tube insertion had improved survival. METHODS Using the 1999-2007 Minimum Data Set matched to Medicare claims, we identified hospitalized nursing home residents with advanced cognitive impairment who did not have a feeding tube inserted prior to their hospital admissions. The sample included 56,824 nursing home residents and 1773 acute care hospitals nationwide. Hospitals were categorized into nine groups based on feeding tube insertion rates and whether the rates were increasing, staying the same, or decreasing between the periods of 2000-2003 and 2004-2007. Multivariate logit models were used to examine the association between the hospital patterns of feeding tube insertion and survival among hospitalized nursing home residents with advanced cognitive impairment. RESULTS Nearly one in five hospitals (N=366) had persistently high rates of feeding tube insertion. Being admitted to these hospitals with persistently high rates of feeding tube insertion was not associated with improved survival when compared with being admitted to hospitals with persistently low rates of feeding tube insertion. The adjusted odds ratios were 0.93 (95% confidence interval [CI]: 0.87, 1.01) and 1.02 (95% CI: 0.95, 1.09) for one-month and six-month posthospitalization survival, respectively. CONCLUSION Hospitals with more aggressive patterns of feeding tube insertion did not have improved survival for hospitalized nursing home residents with advanced cognitive impairment.
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Affiliation(s)
- Shubing Cai
- Program in Public Health, Department of Health Services, Policy & Practice, Brown University, Providence, RI 02912, USA.
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Bourdel-Marchasson I, Guérin O. Nutrition chez le patient adulte atteint de cancer : stratégie thérapeutique en cas de dénutrition du sujet âgé. NUTR CLIN METAB 2012. [DOI: 10.1016/j.nupar.2012.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Cardin F. Special considerations for endoscopists on PEG indications in older patients. ISRN GASTROENTEROLOGY 2012; 2012:607149. [PMID: 23227352 PMCID: PMC3512294 DOI: 10.5402/2012/607149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 10/31/2012] [Indexed: 01/29/2023]
Abstract
Undernutrition in frail elderly people is a pathological condition that needs to be recognized and addressed early. Neurological dysphagia is among the most frequent causes of this condition in the elderly but should be considered a terminal event in Alzheimer-type dementias. Tube feeding is an important resource for facilitating metabolic recovery in cachectic patients and is particularly successful in "bridging" and stabilizing therapies prior to major treatment able to cure the patient. Clinical management of tube feeding in "incurable" conditions is complex and becomes part of the palliative care and comfort provided in the terminal stages of illness. Non-specialized physicians are often unfamiliar with the theory and practice of end-of-life interventions, and the resulting decisions are in many cases actually contrary to patient comfort. These problems deserve to be more carefully addressed when the patient is unable to cooperate or express his/her preferences and needs. The success of percutaneous endoscopic gastrostomy has led to increasingly frequent referrals for placement in critically ill elderly patients. Endoscopists therefore become a key figure in stimulating rational, correct treatment of these patients.
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Affiliation(s)
- Fabrizio Cardin
- Geriatric Surgery Unit, Geriatric Department, Padova University and General Hospital, Via Giustiniani 1, 35100 Padova, Italy
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Smoliner C, Volkert D, Wittrich A, Sieber CC, Wirth R. Basic geriatric assessment does not predict in-hospital mortality after PEG placement. BMC Geriatr 2012; 12:52. [PMID: 22954019 PMCID: PMC3489681 DOI: 10.1186/1471-2318-12-52] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 08/31/2012] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is an established procedure for long-term nutrition. However, studies have underlined the importance of proper patient selection as mortality has been shown to be relatively high in acute illness and certain patient groups, amongst others geriatric patients. Objective of the study was to gather information about geriatric patients receiving PEG and to identify risk factors associated with in-hospital mortality after PEG placement. METHODS All patients from the GEMIDAS database undergoing percutaneous endoscopic gastrostomy in acute geriatric wards from 2006 to 2010 were included in a retrospective database analysis. Data on age, gender, main diagnosis leading to hospital admission, death in hospital, care level, and legal incapacitation were extracted from the main database of the Geriatric Minimum Data Set. Self-care capacity was assessed by the Barthel index, and cognitive status was rated with the Mini Mental State Examination or subjectively judged by the clinician. Descriptive statistics and group comparisons were chosen according to data distribution and scale of measurement, logistic regression analysis was performed to examine influence of various factors on hospital mortality. RESULTS A total of 1232 patients (60.4% women) with a median age of 82 years (range 60 to 99 years) were included. The mean Barthel index at admission was 9.5 ± 14.0 points. Assessment of cognitive status was available in about half of the patients (n = 664), with 20% being mildly impaired and almost 70% being moderately to severely impaired. Stroke was the most common main diagnosis (55.2%). In-hospital mortality was 12.8%. In a logistic regression analysis, old age (odds ratio (OR) 1.030, 95% confidence interval (CI) 1.003-1.056), male sex (OR 1.741, 95% CI 1.216-2.493), and pneumonia (OR 2.641, 95% CI 1.457-4.792) or the diagnosis group 'miscellaneous disease' (OR 1.864, 95% CI 1.224-2.839) were identified as statistical risk factors for in-hospital death. Cognitive status did not have an influence on mortality (OR 0.447, CI 95% 0.248-1.650). CONCLUSION In a nationwide geriatric database, no component of the basic geriatric assessment emerged as a significant risk factor for mortality after PEG placement, emphasizing individual decision-making.
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Affiliation(s)
- Christine Smoliner
- Department of Internal Medicine and Geriatrics, St,-Marien-Hospital Borken, Am Boltenhof 7, 46325, Borken, Germany
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Salpeter SR, Luo EJ, Malter DS, Stuart B. Systematic review of noncancer presentations with a median survival of 6 months or less. Am J Med 2012; 125:512.e1-6. [PMID: 22030293 DOI: 10.1016/j.amjmed.2011.07.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 05/28/2011] [Accepted: 07/09/2011] [Indexed: 12/22/2022]
Abstract
PURPOSE We report on clinical indicators of 6-month mortality in advanced noncancer illnesses and the effect of treatment on survival. METHODS The MEDLINE database was searched comprehensively to find studies evaluating survival for common advanced noncancer illnesses. We retrieved and evaluated studies that reported a median survival of ≤1 year and evaluated prognostic factors or effect of treatment on survival. We extracted data on presentations with median survivals of ≤6 months for heart failure, chronic obstructive pulmonary disease, dementia, geriatric failure to thrive, cirrhosis, and end-stage renal failure. Independent risk factors for survival were combined and included if their combination was associated with a 6-month mortality of ≥50%. RESULTS The search identified 1000 potentially relevant studies, of which 475 were retrieved and evaluated, and 74 were included. We report the common clinical presentations that are consistently associated with a 6-month median survival. Even though advanced noncancer syndromes differ clinically, a universal set of prognostic factors signals progression to terminal disease, including poor performance status, advanced age, malnutrition, comorbid illness, organ dysfunction, and hospitalization for acute decompensation. Generally, a 6-month median survival is associated with the presence of 2-4 of these factors. With few exceptions, these terminal presentations are quite refractory to treatment. CONCLUSION This systematic review summarizes prognostic factors common to advanced noncancer illness. There is little evidence at present that treatment prolongs survival at these terminal stages.
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Complications and Mortality After Percutaneous Endoscopic Gastrostomy in Geriatrics: A Prospective Multicenter Observational Trial. J Am Med Dir Assoc 2012; 13:228-33. [DOI: 10.1016/j.jamda.2011.07.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Revised: 06/09/2011] [Accepted: 07/18/2011] [Indexed: 11/24/2022]
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Onder A, Kapan M, Arikanoglu Z, Gul M, Bestas R, Palanci Y, Karaman H, Bac B. Percutaneous Endoscopic Gastrostomy: Mortality and Risk Factors for Survival. Gastroenterology Res 2012; 5:21-27. [PMID: 27785174 PMCID: PMC5051037 DOI: 10.4021/gr402w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2012] [Indexed: 01/01/2023] Open
Abstract
Background The present study evaluated long-term risk factors for survival in patients who have undergone Percutaneous endoscopic Gastrostomy, as well as morbidity and mortality rates. Methods The retrospective study included 44 patients who underwent placement of a percutaneous endoscopic gastrostomy tube at various departments at Dicle University Medical Faculty between April 2008-September 2010. Results The study evaluated 23 women (52.3%) and 21 men (47.7%), with a median age of 50 ± 20 (17 - 87) years. Median time for Percutaneous endoscopic Gastrostomy placement was 23 ± 8.3 (5 - 45) minutes per patient. Total morbidity was 15.9%, including wound infection (4), tube occlusion (1), peristomal leakage (1), and abdominal wall bleeding (1). Short-term complications were not associated with albumin level (P = 0.312).The median hospital stay was 49.34 ± 60.99 (1 - 314) days. The mean follow-up period was 13.07 ± 13.12 (1 - 41) months. The above-normal level of albumin was found to be effective on survival (P = 0.024). Mortality occurred in 18 (40.9%) patients during the follow-up. Conclusions Percutaneous endoscopic Gastrostomy is both safe and effective in that it does not require surgical operation and it can be performed under surface anesthesia. The serum albumin level with patients who have undergone percutaneous endoscopic gastrostomyis an effective factor for survival.
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Affiliation(s)
- Akin Onder
- Department of Surgery, Dicle University Faculty of Medicine, 21280, Diyarbakir, Turkey
| | - Murat Kapan
- Department of Surgery, Dicle University Faculty of Medicine, 21280, Diyarbakir, Turkey
| | - Zulfu Arikanoglu
- Department of Surgery, Dicle University Faculty of Medicine, 21280, Diyarbakir, Turkey
| | - Mesut Gul
- Department of Surgery, Dicle University Faculty of Medicine, 21280, Diyarbakir, Turkey
| | - Remzi Bestas
- Department of Gastroenterology, Dicle University Faculty of Medicine, 21280, Diyarbakir, Turkey
| | - Yilmaz Palanci
- Department of Public Health, Dicle University Faculty of Medicine, 21280, Diyarbakir, Turkey
| | - Haktan Karaman
- Departmant of Anesthesia and Reanimation, Dicle University Faculty of Medicine, 21280, Diyarbakir, Turkey
| | - Bilsel Bac
- Department of Surgery, Dicle University Faculty of Medicine, 21280, Diyarbakir, Turkey
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Terai S, Iwasa Y. [A retrospective study of outcome of percutaneous endoscopic gastrostomy in older adults with advanced cognitive impairment and severely reduced activities of daily living]. Nihon Ronen Igakkai Zasshi 2012; 49:602-607. [PMID: 23459651 DOI: 10.3143/geriatrics.49.602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM To investigate the outcome of percutaneous endoscopic gastrostomy (PEG) in elderly patients with swallowing difficulties who required high-level nursing care. METHODS We extracted the data of 57 patients (24 men and 33 women) who were admitted to our hospital with a diagnosis of pneumonia over a 5-year study period between January 2006 and December 2010. Evaluation included activities of daily living (ADL), nursing care level (NCL) based on assessment of care requirement, pre-existing disease, blood test data, swallowing function before PEG, and outcome. RESULTS The mean age of the patients was 84.7±8.3 years old. The mean total functional independence measure (FIM) score was 29.7±16.2 and the median NCL value was 4. The most frequently observed pre-existing diseases were degenerative central nervous system disorders including Alzheimer's disease and cerebrovascular disease, which occurred in approximately 80% of participants. A low serum albumin value and high c-reactive protein (CRP) level were also often observed, suggesting chronic inflammatory conditions. For swallowing function, the median value according to the Fujishima swallowing grading system was 5, and aspiration and pharyngeal residues were observed on videofluoroscopic examination of swallowing (VF) (82.5% and 100% of all cases, respectively). The median survival time after PEG was 451.0±79.7 days, with a one-year survival rate of approximately 56%. A total of 51 patients (89.5%) died after PEG and the mean duration from the PEG to death was 518.5±471.7 days. Of these 51, 45 (88.2%) died of pneumonia. CONCLUSIONS In patients with advanced cognitive impairment and severely reduced ADL, there appears to be little benefit on ADL and the prevention of pneumonia by PEG, and most outcomes following PEG were not favorable in the current results.
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Fine MD. Employment and Informal Care: Sustaining Paid Work and Caregiving in Community and Home-based Care. AGEING INTERNATIONAL 2011. [DOI: 10.1007/s12126-011-9137-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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