Introduction Percutaneous gastrostomy insertion is a common procedure performed for a route of enteral nutrition. There are a number of studies observing outcomes in patients in whom PEG is performed. We carried out an audit to review patients who are referred for PEG, assessed as unsuitable, and observed their outcome.
Method We retrospectively identified patients who were directly referred for PEG assessment and deemed unsuitable for PEG placement via our electronic nutrition team referral system from March 2013 –February 2014. Outcomes of all referrals were recorded electronically. There were a total of 103 patients (n = 103; female 51, male 52, average age 74 years (age range 29–97 years)). We analysed the following parameters: referral to review time, reasons for unsuitability, 30 day mortality outcome, total mortality outcome including inpatient vs discharge, by 21 months follow up.
Results 87% of patients had a ward review by the nutrition team. The remaining 13% were discussed via telephone. 93% patients were reviewed within 7 days, 55% patients within 72 h.
The most frequent cause for unsuitability remained palliation (26%) or improvement in oral intake such that PEG was no longer required (22%). Other factors included patients who were clinically unstable and unwell for PEG insertion (10%), deterioration (11%), and anatomical factors.
30 day mortality was 38% (39 /103). Of these patients, 82% (32) died in hospital with 18% (7) discharged. 29 of in hospital death patients had a mortality review by our follow up period. The majority 39% (14) died of pneumonia, mostly commonly aspiration pneumonia.
A further 22 patients (37%) deteriorated over 30 days with overall total mortality of 59% (61/103). 36 patients (35%) in total died within hospital during the referral admission or subsequent admission
5 patients (5%) died on the day of or prior to review. 17% patients died within 2 weeks of review by the nutrition team.
41% patients survived at 21 month follow up, who had improved or at risk oral intake or enteral nutrition.
Conclusion Our results show that there is a high 30 day and total mortality rate, in our cohort unsuitable for PEG insertion suggesting that our assessment of such patients is appropriate given their mortality would be significantly increased if they had undergone PEG insertion. This highlights the importance of appropriate clinical assessment and patient selection when considering suitability for PEG insertion.
17% of patients died within 2 weeks highlighting the number of patients inappropriately referred to the Nutrition Team for consideration of PEG and perhaps raises the need for greater education of allied medical specialities in understanding the risk of PEG placement and factors to consider when identifying patients who may benefit from PEG placement.
Disclosure of interest None Declared.