High In-hospital Mortality Following Percutaneous Endoscopic Gastrostomy: Results of a Nationwide Population-based Study.
Clin Gastroenterol Hepatol. 2013 Apr 16;
Authors: Arora G, Rockey D, Gupta S
BACKGROUND & AIMS: Careful selection of patients who undergo endoscopic procedures plays an important role in optimizing healthcare. Percutaneous endoscopic gastrostomy (PEG) is a frequently performed invasive endoscopic procedure that has been associated with high short-term mortality. We used a national database to determine the incidence of, and factors associated with in-hospital mortality among patients undergoing PEG. METHODS: We conducted a nested, case-control, retrospective study using the US Nationwide Inpatient Sample (NIS) to analyze data from all hospitalizations in the year 2006 with an ICD-9 procedure code for PEG. Bivariate and multivariate logistic regression analysis was performed using demographic and clinical variables to identify predictors of in-hospital mortality following the procedure. A separate analysis using propensity score matching technique was conducted to compare mortality to a control cohort. Results were validated in an independent analysis of 2007 NIS data. RESULTS: In-hospital mortality was 10.8% (95% CI 10.3%-11.3%) among 181,196 patients who underwent PEG in 2006. Odds of death increased with age (1%/y), congestive heart failure, renal failure, chronic pulmonary disease, coagulopathy, pulmonary circulation disorders, metastatic cancer and liver disease. Indication for PEG was strongly associated with mortality. Women, and patients with diabetes mellitus or paralysis had lower odds of death. PEG was associated with slightly higher odds of in-hospital mortality compared to controls. Results were qualitatively and quantitatively similar when 2007 NIS data were analyzed. CONCLUSIONS: Mortality is almost 11% among hospital in-patients following PEG. We have identified factors that increase and decrease the risk of death following PEG; these could improve patient selection for those most likely to benefit from this procedure.
PMID: 23602822 [PubMed - as supplied by publisher]