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Improving 30-day mortality following percutaneous endoscopic gastrostomy tube placement in England from 2007 to 2019: a retrospective national cohort analysis of 87,862 patients
Kamran, Umair Lee, Pui Chi Coupland, Ben Abbasi, Abdullah Ispoglou, Sissi Varyani, Fumi Trudgill, Nigel
Kamran, Umair
Lee, Pui Chi
Coupland, Ben
Abbasi, Abdullah
Ispoglou, Sissi
Varyani, Fumi
Trudgill, Nigel
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2022-07-04
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Abstract
Background and aims Percutaneous endoscopic gastrostomy (PEG) has been associated with poor case selection and high mortality. We examined indications, 30-day mortality and 7-day complications in a national cohort undergoing PEG insertion. Methods Adults undergoing first PEG insertion from 2007–2019 were identified in Hospital Episode Statistics. The indications and complications were identified using ICD-10 codes. Multivariable logistic regression modelling examined factors associated with mortality. Results 87,682 patients identified; 58% male; median age 69 (IQR 57-79) years. The number of patients with dementia or stroke as PEG indication fell from 2007 to 2019 : dementia - 147 to 28, p<0.001; stroke - 2851 to 1781, p<0.001. Median interval from stroke admission to PEG insertion increased from 21 (IQR 12-36) to 28 (13-45) days, p<0.001. Aspiration pneumonia within 7 days of PEG fell from 10.2% to 8.6%, p 0.04. 30 day mortality fell from 13.2% to 5.3% (p<0.001) and factors associated included: increasing age (≥ 82 years quintile odds ratio 4.44 (95% CI 4.01-4.92)); PEG insertion during emergency admission (2.10 (1.97-2.25)); Charlson comorbidity score ≥ 5 (1.67 (1.53-1.82)); and dementia (1.46 (1.26-1.71)).Female sex (0.81 (0.77-0.85)), least deprived quintile (0.88 (0.81-0.95)), and more recent years of PEG insertion (2019, 0.44 (0.39-0.51)) were negatively associated with mortality. Conclusions 30 day mortality following PEG insertion has fallen 60% over 13 years. Dementia or stroke as a PEG indication fell and the time interval from stroke to PEG insertion increased. These findings may be attributable to improved patient selection and timing for PEG insertion.
Citation
Kamran, U., Lee, P.C., Coupland, B., Abbasi, A., Steed, H., Ispoglou, S., Varyani, F. and Trudgill, N. (2022) Improving 30-day mortality following percutaneous endoscopic gastrostomy tube placement in England from 2007 to 2019: a retrospective national cohort analysis of 87,862 patients. Gastrointestinal Endoscopy, 96(6), pp. P943-953. DOI:https://doi.org/10.1016/j.gie.2022.06.031
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Journal article
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en
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This is an accepted manuscript of an article published by Elsevier on 04/07/2022, available online: https://doi.org/10.1016/j.gie.2022.06.031 The accepted version of the publication may differ from the final published version.
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0016-5107