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Enteral nutrition
PMO-075 30-Day mortality risk factors for percutaneous endoscopic and radiologically-inserted gastrostomy
  1. F M Laskaratos,
  2. M Walker,
  3. V Wojciechowska,
  4. A Jenkins
  1. Department of Gastroenterology, Princess Royal University Hospital, London, UK

Abstract

Introduction Gastrostomy insertion is of benefit in selected patients,1 but 30-day mortality is as high as 54% in some patient groups.2 Risk factors associated with early mortality include advanced dementia, age > 75 years, serum albumin <30 g/l, C-reactive protein >10 mg/l, cardiovascular and respiratory comorbidities.3 4 The Sheffield scoring system has been developed to identify patients at risk of early death.5 The current study examines risk factors associated with 30-day mortality in a cohort of patients who underwent percutaneous endoscopic gastrostomy (PEG) or radiologically-inserted gastrostomy (RIG) in a district general hospital over a 12-month period.

Methods A retrospective review was made of case notes of all patients who underwent a PEG (n=26) or RIG (n=16) insertion in the period July 2010–July 2011. PEG/RIG re-insertions were excluded. Demographic, clinical and biochemical data were analysed.

Results The main indications for a PEG/RIG insertion were cerebrovascular accident (n=14), chronic neuromuscular disease (n=10), oropharyngeal malignancy (n=8), intracerebral pathology other than stroke (n=6), cognitive impairment (n=2), ICU neuropathy (n=1) and somatisation disorder (n=1). The overall 30-day mortality was 7/42 (16.7%). The main risk factors associated with 30-day mortality were age > 75 years (p<0.05) and cardiovascular co-morbidities (p<0.01). The serum albumin, C-reactive protein and respiratory comorbidities were not associated with early mortality. There was no correlation between 30-day mortality and Sheffield score.

Conclusion In keeping with other studies, age > 75 years and cardiovascular co-morbidities were associated with 30-day mortality after gastrostomy insertion. However, other previously identified risk factors did not correlate with early mortality in this group of patients.

Competing interests None declared.

References 1. Westaby D, et al. The provision of a percutaneously placed enteral tube feeding service. Gut 2010;59:1592–605.

2. Sanders D, et al. Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia. Am J Gastroenterol 2000;95:1472–5.

3. Janes S, et al. Percutaneous endoscopic gastrostomy: 30-day mortality trends and risk factors. J Postgrad Med 2005;51:23–8.

4. Blomberg J. Albumin and C-reactive protein levels predict short-term mortality after percutaneous endoscopic gastrostomy in a prospective cohort study. Gastrointestinal Endoscopy 2011;73:29–36.

5. Leeds J. Albumin level and patient age predict outcomes in patients referred for gastrostomy insertion: internal and external validation of a gastrostomy score and comparison with artificial neural networks. Gastrointestinal Endoscopy 2011;74:1033–9.

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