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

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.

Percutaneous Endoscopic Gastrostomy. Are we doing the better for all patients?

“…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.…”

“…The indication of a medical treatment to a patient who will die in the near future is a futile indication. 1 The patients will suffer the risks of PEG, and there will be charges which must be considered-all for zero benefits.…”

“…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).…”

Mortality and complications after percutaneous endoscopic gastrostomy: a retrospective multicentre study

“…Although PEG is considered a relatively safe and effective method for inserting a gastric tube, previous studies have shown that minor complications (for example local infection, local bleeding, leakage around the stoma, dislocation of the tube, tube blockage and local pain) occur in 18%-38% of all patients, major complications (for example, aspirational pneumonia, organ damage, major bleeding and peritonitis) occur in 2%-4% and the 30-day mortality is reported to be between 3 and 23% [13][14][15][16][17][18][19]. The risk of complications after PEG has been found to be increased in patients with other medical conditions such as diabetes mellitus and malignancy and among patients with anti-coagulant therapy or patients treated with corticosteroids [18,20,21].…”

“…Apart from the risk of complications, some studies have found associations between 30-day mortality and high serum C-reactive protein (CRP) levels, low serum albumin levels, low serum thrombocyte levels, anaemia, old age, chronic obstructive lung disease, ischemic heart disease, underlying neurological disease and recent treatment in an intensive care unit, although the findings are not consistent [13][14][15][16][17][18][19][20][21][22][23]. Due to the conflicting results of previous studies we aimed to study comorbidities and outcomes in patients undergoing a PEG procedure in a routine clinical setting.…”