Mortality Among Patients Who Receive or Defer Gastrostomies.
Clin Gastroenterol Hepatol. 2013 Apr 29;
Authors: Kurien M, Leeds JS, Delegge MH, Robson HE, Grant J, Lee FK, McAlindon ME, Sanders DS
BACKGROUND & AIMS: There are few data on outcomes and mortality of patients who have received gastrostomies. We assessed 30-day and 1-year mortalities of patients in the UK who were referred to hospitals for gastrostomies, and of patients who deferred this intervention. METHODS: We collected data from 1327 patients referred to 2 hospitals in Sheffield, UK for gastrostomies from February 2004 through May 2010. Data were analyzed to determine 30-day and 1-year mortalities. Predicted mortality using the validated Sheffield Gastrostomy Scoring System (SGSS) was then compared with actual mortality using area under the receiver operator curves (AUC), to determine levels of agreement in patients referred for gastrostomy. RESULTS: Three-hundred four patients (23%) did not undergo gastrostomy following multi-disciplinary team discussion, based on physicians' recommendations. This group had 35.5% mortality at 30 days and 74.3% at 1 year, whereas mortality among patients who underwent gastrostomy (n=1027) was 11.2% at 30 days and 41.1% at 1-year (P<.0001, compared with patients who deferred the procedure). The AUC for the SGSS demonstrated acceptable agreement between predicted and actual mortality in both patients who underwent or were deferred gastrostomy. CONCLUSIONS: Based on data from 1327 patients, those who undergo gastrostomy have significantly lower mortality than those who defer the procedure. Without applying the SGSS, clinicians are able to select patients most likely to benefit from gastrostomy. The SGSS could provide objective support to clinicians involved in making ethically contentious or potentially litigious decisions. STUDY REGISTRATION: This study was registered with the Sheffield Research and Development department under the number STH09/H1310/2.
PMID: 23639596 [PubMed - as supplied by publisher]