Mortality risk factors after percutaneous gastrostomy: Who is a good candidate?

Tabuenca, Ana Agudo; Trallero, Jara Altemir; Orna, José Antonio Gimeno; Bretón, María Julia Ocón

doi:10.1016/j.clnu.2018.02.018

Cited by 10 publications

(15 citation statements)

References 22 publications

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“…Age and malignancy were also risk factors described by some authors. 3 , 5 , 16 , 19 , 21 Our sample was not enough to accurately study the effects of serum albumin, serum sodium, and C-reactive protein in early mortality due to the absence of these values in many patients: chiefly albumin and C-reactive protein.…”

Section: Discussionmentioning

confidence: 99%

“…Life expectancy lower than two months and end-stage chronic diseases are contraindications to the procedure. 5 Although this procedure is fast and safe, it is not free of complications and is associated with early mortality rates, 3 , 6 , 7 demonstrating the need for a better and objective patient selection criterion to avoid futile indications and wasting resources. Different authors have identified risk factors associated with early mortality, and, thus, it is important to elaborate a clinical protocol to protect patients who would not benefit from this endoscopic procedure.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with 30-Day Mortality in Patients after Percutaneous Endoscopic Gastrostomy

Lima¹,

Miranda²,

Penha³

et al. 2021

JSLS

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors Associated with 30-Day Mortality in Patients after Percutaneous Endoscopic Gastrostomy

Lima¹,

Miranda²,

Penha³

et al. 2021

JSLS

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“…A higher mortality rate and procedure‐related complications have been reported in head and neck cancer patients than in the general population [22, 27]. A recent retrospective study revealed that malignancies were an independent risk factor associated with mortality in patients who underwent gastric tube feeding [28].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Outcomes Between Surgical Gastrostomy and Percutaneous Endoscopic Gastrostomy with Introducer Technique in Patients with Upper Aerodigestive Malignancies: A Single‐Center Analysis

et al. 2020

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Background Conventional percutaneous endoscopic gastrostomy (PEG) in patients with upper aerodigestive malignancies inevitably carries a risk of stomal metastasis that could be avoided by the direct insertion of the gastrostomy tube through the abdomen. This study compared the efficacy and safety between surgical gastrostomy (SG) and Introducer PEG in patients with upper aerodigestive malignancies. Methods We retrospectively reviewed patients with upper aerodigestive malignancies undergoing SG or Introducer PEG. Procedure data, postprocedural clinical outcomes and 30-day mortality were assessed. Results In total, 99 patients were feasible to analysis: 53 were in the SG group, and 46 were in the Introducer PEG group. The SG group had a higher incidence of (in-hospital) major complications [28.3% VS 4.3%, p = 0.002], a longer procedure duration [52.02 ± 21.30 VS 21.46 ± 8.22 min, p \ 0.001], higher pain scores at 24 h [median (interquartile range, IQR); 5(3-8) VS 1(0-5), p \ 0.001] and longer length of hospitalization (LOH) [median (IQR); 5(4-6) days VS 3(2-4) days, p \ 0.001)]. In-hospital (3.8% VS 0%, p = 0.493) and 30-day mortality (17.0% VS 13.0%, p = 0.586) were not different between the two groups. In univariate analysis, high BMI, anemia (hemoglobin \11 g/dL), normal nutritional status (serum albumin [3 g/dL) and procedural type were found to be predicting factors for complications. Procedural type (Introducer PEG) was an independent factor for major complications in multivariate analysis [OR = 0.12, 95% CI 0.02-0.61, p= 0.011]. Conclusions In patients with upper aerodigestive malignancies, Introducer PEG was associated with lower rate of (in-hospital) major complications, faster operative time, lower pain scores and shorter LOH.

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“…Authors have made efforts to investigate risk factors associated with early mortality after PEG. 1,[4][5][6][7][8][9][10] Most of these investigations are retrospective surveys, which have natural limitations: no control group, no randomized patients and missing data. These surveys have demonstrated two main groups of risk factors related to early mortality after PEG: factors associated with malnutrition (hypoalbuminemia, anemia, malnutrition) or factors associated with chronic disease (diabetes, coronary disease, age, etc).…”

mentioning

confidence: 99%

“…These surveys have demonstrated two main groups of risk factors related to early mortality after PEG: factors associated with malnutrition (hypoalbuminemia, anemia, malnutrition) or factors associated with chronic disease (diabetes, coronary disease, age, etc). 4,5,7,[10][11][12] We recently published a paper that investigated the risk factors associated with 30day mortality in patients who submitted to PEG at the Unimed Recife III Hospital. 1 We concluded that anemia and a recent past of ICU hospitalization are risk factors related to 30-day mortality after PEG.…”

mentioning

confidence: 99%