Improving All-Cause Inpatient Mortality After Percutaneous Endoscopic Gastrostomy

Abstract

Background and Aims

Percutaneous gastrostomy (PEG) is a common inpatient procedure. Prior data from National Inpatient Sample (NIS) in 2006 reported a mortality rate of 10.8% and recommended more careful selection of PEG candidates. This study assessed for improvement in the last 10 years in mortality rate and complications for hospitalized patients.

Methods

A retrospective cohort analysis of all adult inpatients in the NIS from 2006 to 2016 undergoing PEG placement compared demographics and indication for PEG placement per ICD coding. Survey-based means and proportions were compared to 2006, and rates of change in mortality and complication rates were trended from 2006 through 2016 and compared with linear regression. Multivariable survey-adjusted logistic regression was used to determine predictors of mortality and complications in the 2016 sample.

Results

A total of 155,550 patients underwent PEG placement in 2016, compared with 174,228 in 2006. Mortality decreased from 10.8 to 6.6% without decreased comorbidities (p < 0.001). This trend was gradual and persistent over 10 years in contrast to a stable overall inpatient mortality rate (p = 0.113). Stroke remained the most common indication (29.7%). The majority of patients (64.6%) had Medicare. Indications for placement were stable. Complication rates were stable from 2006 (4.4%) to 2016 (5.1%) (p = 0.201).

Conclusions

Inpatient PEG placement remains common. Despite similar patient characteristics, mortality has decreased by approximately 40% over the last 10 years without a decrease in complications likely reflecting improved patient selection.

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Contributions

JF was guarantor of the article. DJS and JDF studied concept and design. MBM and DJS were involved in acquisition of data. DJS, MBM, and JDF were involved in analysis and interpretation of data. MBM, DJS, GH, and JDF contributed to drafting of the manuscript. MBM, DJS, GH, and JDF contributed to critical revision of the manuscript for important intellectual content. MBM, DJS, GH, and JDF were involved in final approval of the article. DJS contributed to statistical analysis. JDF contributed to study supervision. Each author has approved the final draft of this manuscript.

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Correspondence to Daniel J. Stein.

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Daniel J. Stein and Matthew B. Moore have contributed equally to this work.

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Stein, D.J., Moore, M.B., Hoffman, G. et al. Improving All-Cause Inpatient Mortality After Percutaneous Endoscopic Gastrostomy. Dig Dis Sci (2020). https://doi.org/10.1007/s10620-020-06396-y

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Keywords

  • PEG tube
  • Gastrostomy tube
  • Complications
  • Quality of care
  • Hospitalization
  • Mortality