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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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Essat M, Coates E, Clowes M, Beever D, Hackney G, White S, Stavroulakis T, Halliday V, McDermott C. Understanding the current nutritional management for people with amyotrophic lateral sclerosis - A mapping review. Clin Nutr ESPEN 2022; 49:328-340. [DOI: 10.1016/j.clnesp.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/17/2022] [Accepted: 03/13/2022] [Indexed: 11/16/2022]
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3
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Lima DL, Miranda LEC, da Penha MRC, Lima RNCL, Dos Santos DC, Eufrânio MS, Miranda ACG, Pereira LMMB. Factors Associated with 30-Day Mortality in Patients after Percutaneous Endoscopic Gastrostomy. JSLS 2021; 25:JSLS.2021.00040. [PMID: 34456551 PMCID: PMC8372986 DOI: 10.4293/jsls.2021.00040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Percutaneous endoscopic gastrostomy (PEG) is the main accepted method for long-term tube feeding. The aim of this study is to investigate the risk factors associated with early mortality after PEG. Methods: It is a retrospective survival analysis in a tertiary-level hospital. We reviewed the medical records of 277 patients with PEG placement. The data were analyzed by the Kaplan-Meier method. Multivariable Cox proportional regression models were also built to test the effects of PEG on mortality. Results: A total of 277 patients who submitted to PEG were studied. One-hundred and sixty (58%) were female, mean age of 73.3 ± 15.7 years. Ninety-three patients (33.6%) had diabetes mellitus and 165 (59.6%) had blood hypertension. The indications for PEG placement were chronic neurologic dysphagia in 247 (89.5%) patients and tumors and other diseases in 29 (10.5%). The 30 days proportional mortality probability rate was 13%. In a multivariate Cox proportional regression model, preoperative ICU hospitalization (HR 1.79, 95% CI 1.36–2.36, P = 0.000) and hemoglobin (HR 0.91, 95% CI 0.85–0.98, P = 0.015) were predictors of early mortality. Conclusion: In patients who had underwent PEG tube insertion for long-term nutrition, anemia and previous ICU admission were predictors of mortality at four weeks. These factors may guide physicians to discourage the indication for PEG.
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Affiliation(s)
- Diego L Lima
- Department of Surgery, Montefiore Medical Center, The Bronx, New York, USA
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Costa D, Despott EJ, Lazaridis N, Woodward J, Kohout P, Rath T, Scovell L, Gee I, Hindryckx P, Forrest E, Hollywood C, Hearing S, Mohammed I, Coppo C, Koukias N, Cooney R, Sharma H, Zeino Z, Gooding I, Murino A. Multicenter cohort study of patients with buried bumper syndrome treated endoscopically with a novel, dedicated device. Gastrointest Endosc 2021; 93:1325-1332. [PMID: 33221321 DOI: 10.1016/j.gie.2020.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Buried bumper syndrome (BBS) is a rare adverse event of percutaneous endoscopic gastrostomy (PEG) placement in which the internal bumper migrates through the stomal tract to become embedded within the gastric wall. Excessive tension between the internal and external bumpers, causing ischemic necrosis of the gastric wall, is believed to be the main etiologic factor. Several techniques for endoscopic management of BBS have been described using off-label devices. The Flamingo set is a novel, sphincterotome-like device specifically designed for BBS management. We aimed to evaluate the effectiveness of the Flamingo device in a large, homogeneous cohort of patients with BBS. METHODS A guidewire was inserted through the external access of the PEG tube into the gastric lumen. The Flamingo device was then introduced into the stomach over the guidewire. This dedicated tool can be flexed by 180 degrees, exposing a sphincterotome-like cutting wire, which is used to incise the overgrown tissue until the PEG bumper is exposed. A retrospective, international, multicenter cohort study was conducted on 54 patients between December 2016 and February 2019. RESULTS The buried bumper was successfully removed in 53 of 55 procedures (96.4%). The median time for the endoscopic removal of the buried bumper was 22 minutes (range, 5-60). Periprocedural endoscopic adverse events occurred in 7 procedures (12.7%) and were successfully managed endoscopically. A median follow-up of 150 days (range, 33-593) was performed in 29 patients (52.7%), during which no significant adverse events occurred. CONCLUSIONS Through our experience, we found this dedicated novel device to be safe, quick, and effective for minimally invasive, endoscopic management of BBS.
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Affiliation(s)
- Deborah Costa
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Jeremy Woodward
- Department of Gastroenterology and Clinical Nutrition Addenbrooke's Hospital, Cambridge, UK
| | - Pavel Kohout
- Department of Internal Medicine Thomayer Hospital, Prague, Czech Republic
| | - Timo Rath
- Division of Gastroenterology, Department of Medicine, Erlangen University Hospital, Erlangen, Germany
| | - Louise Scovell
- Gastrointestinal and Liver services Ipswich Hospital, Ipswich, UK
| | - Ian Gee
- Department of Gastroenterology, Worcestershire Acute Hospital, Worcester, UK
| | - Pieter Hindryckx
- Department of Gastroenterology, University Hospital of Ghent, Ghent, Belgium
| | - Ewan Forrest
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Coral Hollywood
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - Stephen Hearing
- Department of Gastroenterology and Hepatology, University Hospitals of Derby and Burton, Derby, UK
| | - Imtiyaz Mohammed
- Department of Gastroenterology Sandwell and West Birmingham Hospitals, Lyndon, West Bromwich, West Midlands, UK
| | - Claudia Coppo
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Rachel Cooney
- Department of Gastroenterology, University Hospitals Birmingham, Birmingham, UK
| | - Hemant Sharma
- Gastrointestinal and Liver Services, Maidstone and Tunbridge Wells Hospital, Maidstone and Pembury, UK
| | - Zeino Zeino
- Department of Gastroenterology and Hepatology, North Bristol Trust, Bristol, UK
| | - Ian Gooding
- Department of Gastroenterology, Colchester General Hospital, Colchester, UK
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
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Gkolfakis P, Arvanitakis M, Despott EJ, Ballarin A, Beyna T, Boeykens K, Elbe P, Gisbertz I, Hoyois A, Mosteanu O, Sanders DS, Schmidt PT, Schneider SM, van Hooft JE. Endoscopic management of enteral tubes in adult patients - Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53:178-195. [PMID: 33348410 DOI: 10.1055/a-1331-8080] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
ESGE recommends the "pull" technique as the standard method for percutaneous endoscopic gastrostomy (PEG) placement.Strong recommendation, low quality evidence.ESGE recommends the direct percutaneous introducer ("push") technique for PEG placement in cases where the "pull" method is contraindicated, for example in severe esophageal stenosis or in patients with head and neck cancer (HNC) or esophageal cancer.Strong recommendation, low quality evidence.ESGE recommends the intravenous administration of a prophylactic single dose of a beta-lactam antibiotic (or appropriate alternative antibiotic, in the case of allergy) to decrease the risk of post-procedural wound infection.Strong recommendation, moderate quality evidence.ESGE recommends that inadvertent insertion of a nasogastric tube (NGT) into the respiratory tract should be considered a serious but avoidable adverse event (AE).Strong recommendation, low quality evidence.ESGE recommends that each institution should have a dedicated protocol to confirm correct positioning of NGTs placed "blindly" at the patient's bedside; this should include: radiography, pH testing of the aspirate, and end-tidal carbon dioxide monitoring, but not auscultation alone.Strong recommendation, low quality evidence.ESGE recommends confirmation of correct NGT placement by radiography in high-risk patients (intensive care unit [ICU] patients or those with altered consciousness or absent gag/cough reflex).Strong recommendation, low quality evidence.ESGE recommends that EN may be started within 3 - 4 hours after uncomplicated placement of a PEG or PEG-J.Strong recommendation, high quality evidence.ESGE recommends that daily tube mobilization (pushing inward) along with a loose position of the external PEG bumper (1 - 2 cm from the abdominal wall) could mitigate the risk of development of buried bumper syndrome.Strong recommendation, low quality evidence.
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Affiliation(s)
- Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Edward J Despott
- Royal Free Unit for Endoscopy and Centre for Gastroenterology, UCL Institute for Liver and Digestive Health, The Royal Free Hospital, London, United Kingdom
| | - Asuncion Ballarin
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Torsten Beyna
- Department of Gastroenterology and Therapeutic Endoscopy, Evangelisches Krankenhaus Düsseldorf, Germany
| | - Kurt Boeykens
- Nutrition Support Team, AZ Nikolaas Hospital, Moerlandstraat 1, 9100, Sint-Niklaas, Belgium
| | - Peter Elbe
- Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.,Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Gisbertz
- Department of Gastroenterology, Bernhoven Hospital, Uden, the Netherlands
| | - Alice Hoyois
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Ofelia Mosteanu
- Department of Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - David S Sanders
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital & University of Sheffield, United Kingdom
| | - Peter T Schmidt
- Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Ersta Hospital, Stockholm, Sweden
| | - Stéphane M Schneider
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Gastroentérologie et Nutrition, Nice, France
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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Grandidge L, Chotiyarnwong C, White S, Denning J, Nair KPS. Survival following the placement of gastrostomy tube in patients with multiple sclerosis. Mult Scler J Exp Transl Clin 2020; 6:2055217319900907. [PMID: 32002190 PMCID: PMC6963323 DOI: 10.1177/2055217319900907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 01/27/2023] Open
Abstract
Background Around a third of people with multiple sclerosis (MS) experience dysphagia. There is a need for disease-specific information on survival following placement of gastrostomy tube in people with MS. Objective We aimed to study survival following gastrostomy in patients with MS. Methods We reviewed medical records, home enteral feeding database and death certificates of people with MS who had gastrostomy from 2005 to 2017. Cox regression analysis was performed to identify independent predictors associated with mortality after gastrostomy. Results Median survival of 53 patients with MS after gastrostomy was 21.73 months. Median duration of hospital stay after gastrostomy was 14 days (IQR 5.25, 51.5). Survival at 30 days, 3 months, 1, 2, 5 and 10 years were 100% (53/53), 98.1% (52/53), 81.1% (43/53), 54.7% (29/53), 22.4% (11/49) and 6.8% (3/44), respectively. Of 53 patients, 24 died due to respiratory tract infection. Patients who had gastrostomy tube before 50 years of age survived longer (median 28.48 months) compared with those who had the gastrostomy after age 50 years (median 17.51 months) (p = 0.040). Conclusion Around 54% of patients with MS survived two or more years following gastrostomy. Younger patients had better survival. The most frequent cause of death was respiratory infection.
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Affiliation(s)
- Lisa Grandidge
- Princess Royal Spinal Injuries and Neurorehabilitation Centre, Northern General Hospital, Herries Road, Sheffield, UK
| | - Chayaporn Chotiyarnwong
- Department of Neuroscience, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Jessica Denning
- Dietetic Department, Northern General Hospital, Herries Road, Sheffield, UK
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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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Porter RJ, McKinlay AW, Metcalfe EL. Gastropexy can be as safe as conventional percutaneous endoscopic gastrostomy (PEG), and biomarkers do not predict short-term or long-term outcomes: a 7-year follow-up audit. Frontline Gastroenterol 2019; 11:364-370. [PMID: 32884630 PMCID: PMC7447287 DOI: 10.1136/flgastro-2019-101306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/16/2019] [Accepted: 10/29/2019] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Gastrostomy facilitates artificial enteral feeding but controversy exists around associated morbidity and mortality. This study aimed to report short and long-term outcomes, and identify parameters associated with overall survival. METHODS A 7-year follow-up audit was undertaken at Aberdeen Royal Infirmary, UK. All patients undergoing endoscopic gastrostomy insertion October 2011-September 2018 were included. Last follow-up was February 2019. Clinical data were prospectively collected. Blood results were retrospectively obtained from electronic records. Statistical analysis was with IBM SPSS V.25. RESULTS 691 procedures were performed over the 7-year period (520 traditional pull-through percutaneous endoscopic gastrostomy (PEG) and 171 gastropexy procedures to facilitate gastrostomy). Frequency of complications (gastrointestinal bleeding, perforation and peritonitis) was low (each n=1). Overall 7-day and 30-day mortality was 2.2% and 8.4%, respectively. One-year mortality reached 47.6%. There was no difference in survival between PEG and gastropexy procedures (p=0.410). Multivariate analysis reported increased age (p<0.001), increased alkaline phosphatase (p<0.001) and clinical indication (p=0.002) as independently associated with an increased hazard of death. Only age was moderately predictive of mortality (area under the curve 0.74, 95% CI 0.70 to 0.78, p<0.001) in the PEG group. Clinical indication was the only parameter independently associated with mortality in the gastropexy cohort (p=0.003). CONCLUSION Endoscopic gastrostomy placement can be safe with a low mortality and low risk of serious complications. Blood markers were not associated with short-term or long-term outcomes. Gastropexy to facilitate gastrostomy is a safe alternative to traditional pull-through PEG procedures. Future work should consider quality of life outcomes to assess the benefit of gastrostomy from a patient perspective.
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Affiliation(s)
- Ross J Porter
- Institute of Medical Sciences, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK,Aberdeen Royal Infirmary Department of Digestive Disorders, NHS Grampian, Aberdeen, UK
| | - Alastair W McKinlay
- Aberdeen Royal Infirmary Department of Digestive Disorders, NHS Grampian, Aberdeen, UK
| | - Emma L Metcalfe
- Aberdeen Royal Infirmary Department of Digestive Disorders, NHS Grampian, Aberdeen, UK
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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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