Reducing 30-day post gastrostomy insertion mortality with a feeding issues multidisciplinary team meeting

Bond, Ashley; Conley, Thomas; Fiske, Janice; Raymond, Valentin; Young, A.; Collins, Paul; Dibb, Martyn; Smith, PA

doi:10.1016/j.clnesp.2020.09.005

Cited by 6 publications

(7 citation statements)

References 17 publications

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“…In previous data and according to a meta-analysis published in 2016, the pooled 30-day PEG mortality rate was reported to be 5.5%, which is similar to our data 24–26. In our unit, as shown by Stein et al ,27 the 30-day mortality rate after PEG insertion has decreased in the last decade.…”

Section: Discussionsupporting

confidence: 91%

“…In our unit, as shown by Stein et al ,27 the 30-day mortality rate after PEG insertion has decreased in the last decade. In comparison, in 2011 and 2012 in our centre, 122 PEG were performed with a 30-day mortality rate of 8.96% (12/122) (personal data) compared with 3.05% in this study despite a stable number of PEG insertions (65.6 per year in 2017–2019 vs 67 per year in 2011–2012) and the use of the same insertion technique 26. The cause of this change remains elusive to us.…”

Section: Discussionmentioning

confidence: 47%

“…In previous data and according to a meta-analysis published in 2016, the pooled 30-day PEG mortality rate was reported to be 5.5%, which is similar to our data. [24][25][26] In our unit, as shown by Stein et al, 27 the 30-day mortality rate after PEG insertion has decreased in the last decade. In comparison, in 2011 and 2012 in our centre, 122 PEG were performed with a 30-day mortality rate of 8.96% (12/122) (personal data) compared with 3.05% in this study despite a stable number of PEG insertions (65.6 per year in 2017-2019 vs 67 per year in 2011-2012) and the use of the same insertion technique.…”

Section: Open Accessmentioning

confidence: 64%

“…In comparison, in 2011 and 2012 in our centre, 122 PEG were performed with a 30-day mortality rate of 8.96% (12/122) (personal data) compared with 3.05% in this study despite a stable number of PEG insertions (65.6 per year in 2017–2019 vs 67 per year in 2011–2012) and the use of the same insertion technique. 26 The cause of this change remains elusive to us. It is most probably due to a better selection of patients and an improvement in the information given to our colleagues of other specialties as well as to patients and their families about the low benefit–risk ratio of PEG insertion in the presence of specific conditions such as dementia.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of 30-day mortality in patients undergoing gastrointestinal endoscopy in a tertiary hospital: a 3-year retrospective survey

Chatelanat

Bichard

Bochatay³

et al. 2022

BMJ Open Gastroenterol

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ObjectiveDespite international guidelines recommendations to use mortality as a quality criterion for gastrointestinal (GI) procedures, recent studies reporting these data are lacking. Our objective was to report death causes and rate following GI endoscopies in a tertiary university hospital.DesignWe retrospectively reviewed all GI procedures made between January 2017 and December 2019 in our tertiary hospital in Switzerland. Data from patients who died within 30 days of the procedure were recorded.ResultsOf 18 233 procedures, 251 patients died within 30 days following 345 (1.89%) procedures (244/9180 gastroscopies, 53/5826 colonoscopies, 23/2119 endoscopic ultrasound, 19/911 endoscopic retrograde cholangiopancreatography, 6/197 percutaneous endoscopic gastrostomies). Median age was 70 years (IQR 61–79) and 173/251 (68.92%) were male. Median Charlson Comorbidity Index was 5 (IQR 3–7), and 305/345 procedures (88.4%) were undertaken on patients with an ASA score ≥3. Most frequent indications were suspected GI bleeding (162/345; 46.96%) and suspected cancer or tumourous staging (50/345; 14.49%). Major causes of death were oncological progression (72/251; 28.68%), cardiopulmonary failure or cardiac arrest of unkown origin (62/251; 24,7%) and liver failure (20/251; 7.96%). No deaths were caused by complications such as perforation or bleeding.ConclusionsProgression of malignancies unrelated to the procedure was the leading cause of short-term death following a GI procedure. After improvements in periprocedural care in the last decades, we should focus on patient selection in this era of new oncological and intensive care therapies. Death rate as a quality criterion is subject to caution as it depends on indication, setting and risk benefit ratio.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 47%

Section: Open Accessmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of 30-day mortality in patients undergoing gastrointestinal endoscopy in a tertiary hospital: a 3-year retrospective survey

Chatelanat

Bichard

Bochatay³

et al. 2022

BMJ Open Gastroenterol

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“…This suggests there is now a more comprehensive, co-ordinated selection process when deciding who should proceed to a gastrostomy and this may have contributed to a reduction in the number of unnecessary procedures. Previous studies have demonstrated how MDT discussion can reduce 30-day gastrostomy mortality,10 as well as PEG complications 11. Alternative methods of gastrostomy may account for some of the reduction in PEGs; however, PEGs are still more common than RIGs in the majority of hospitals and compared with 2010, there has been no change in hospital access to RIG.…”

Section: Discussionmentioning

confidence: 99%

What is the current provision of service for gastrostomy insertion in England?

Parr

Williams

White

et al. 2022

Frontline Gastroenterol

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BackgroundSignificant morbidity and mortality can be associated with gastrostomy insertion, likely influenced by patient selection, indication and aftercare. We aimed to establish what current variation in practice exists and how this has improved by comparison to our previously published British Society of Gastroenterology survey of 2010.MethodsWe approached all National Health Service (NHS) hospitals in England (n=198). Email and web-based questionnaires were circulated. These data were correlated with the National Endoscopy Database (NED).ResultsThe response rate was 69% (n=136/198). Estimated Percutaneous Endoscopic Gastrostomy (PEG) placements in the UK are currently 6500 vs 17 000 in 2010 (p<0.01). There is a dedicated PEG consultant involved in 59% of the centres versus 30% in 2010 (p<0.001). Multidisciplinary team meeting (MDT) discussion occurs in 66% versus 40% in 2010 (p<0.05). Formal aftercare provision occurs in 83% versus 64% in 2010 (p<0.001). 74/107 respondents (69%) reported feeling pressurised to authorise a gastrostomy.ConclusionThis national survey, validated by the results from NED, demonstrates a reduction of over 60% for PEG insertion rates compared with previous estimates. There has also been an increase in consultant involvement, MDT discussion and aftercare provision. However, two-third of responders described ‘pressure’ to insert a gastrostomy. Perhaps further efforts are needed to include and educate other specialty teams, patients and next of kin.

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Ethical decision-making process for percutaneous endoscopic gastrostomy in patients with dysphagia

Shirai

Ueshima

Shimizu³

et al. 2021

Eur Geriatr Med

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Reducing 30-day post gastrostomy insertion mortality with a feeding issues multidisciplinary team meeting

Cited by 6 publications

References 17 publications

Evaluation of 30-day mortality in patients undergoing gastrointestinal endoscopy in a tertiary hospital: a 3-year retrospective survey

Evaluation of 30-day mortality in patients undergoing gastrointestinal endoscopy in a tertiary hospital: a 3-year retrospective survey

What is the current provision of service for gastrostomy insertion in England?

Ethical decision-making process for percutaneous endoscopic gastrostomy in patients with dysphagia

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