Introduction PEG insertion has a reported 30-day mortality of 19%–24%1 2 suggesting a significant number of inappropriate insertions that were unnecessary for good care. Despite this there are no consistent Australian guidelines regarding patient selection for this procedure. To try and identify patients who would not benefit from PEG insertion we conducted an audit of all PEG insertions undertaken at our hospital, with particular reference to indications, complications and outcome.
Methods PEG insertions from 15 January 2009 to 22 July 2011 were identified from an endoscopy database and then medical notes were reviewed. We assessed indication for PEG insertion, the use of prophylactic antibiotics, complications during the procedure, 30 day complications and longer term complication rates.
Results 28 patients were identified (13 male and 15 female). The mean age was 71.8 years. The most common indication for PEG insertion was dysphagia following a cerebrovascular accident (CVA) (65%). Other indications included head and neck tumours (14%), other neurological disorders and poor oral intake due to severe depression (21%). 64% of patients received prophylactic antibiotics during the procedure with cephazolin compared to the recommended 100%. Despite this low rate, no patients were re-admitted with PEG site infections. 30-day mortality was 23%. In patients with CVAs 30-day mortality was 45% vs 0% in patients with other indications (p=0.038; Fishers exact test). Eleven patients had episodes of aspiration within 30 days of PEG insertion—the majority of these were from the CVA group (72%). The median time between CVA and PEG insertion was 25.5 days (range 10–53 days). Overall survival at 1 year was 38%. There were three cases in which the PEG fell out: two of the three were due to the patient removing it.
Conclusion Our data shows a significantly higher 30-day mortality in CVA patients as well as a higher frequency of aspiration in this group. This is in keeping with other studies3 and re-iterates the fact that insertion of a PEG does not prevent the development of aspiration pneumonia, which is a common misconception. It would therefore be reasonable to suggest a minimum period of 30 days of observation plus NG feeding in such patients to allow for any change in clinical condition.
Competing interests None declared.
References 1. Janes SE, Price SG, Khan S. Percutaneous endoscopic gastrostomy: 30-day mortality trends and risk factors. J Postgrad Med 2005;51:23–8.
2. Mitchell SL, Tetroe JM. Survival after percutaneous endoscopic gastrostomy placement in older persons. J Gerontol A Biol Sci Med Sci 2000;55:735–9.
3. Marik PE. Primary care: aspiration pneumonitis and aspiration pneumonia. N Engl J Med 2001;344:665–71.
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