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Journal of Parenteral and Enteral Nutrition
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Article

Understanding Why Patients Die After Gastrostomy Tube Insertion: A Retrospective Analysis of Mortality

Gaius Longcroft-Wheaton, MB, BS, MRCP1*, Peter Marden, MB, BS, MRCP2, Ben Colleypriest, MB, ChB, MRCP3, Daniel Gavin, MB, ChB, MRCP4, Gordon Taylor5, and Mark Farrant, MD, FRCP4

1 St. Richards Hospital Chichester
2 Bristol Royal Infirmary
3 University of Bath
4 Royal United Hospital Bath
5 Wolfston Unit, University of Bath

* To whom correspondence should be addressed. E-mail: gaius{at}gaius.wanadoo.co.uk.


  Abstract
Objectives: To understand the causes of mortality of inpatients receiving a percutaneous endoscopic gastrostomy (PEG) tube compared with a survival curve predicted from a model proposed by Levine et al (2007). Design: A retrospective study of patients receiving a PEG over an 18-month period. Setting: Royal United Hospital Bath, a district general hospital in the southwest of England. Patients: Fifty-five cases, with 44 found eligible for inclusion. Interventions: A Levine score was calculated for this cohort. A survival curve after PEG was produced and compared with the Kaplan-Meier curve predicted by the Levine model. Main Outcome Measures: Mortality over a period of 1 year. Results: The mortality at 1, 3, 6, and 12 months was 16%, 20%, 25%, and 28%, respectively. This matched the predicted death rate from the Levine model closely (Pearson’s rank correlation coefficient = 0.96). Conclusions: The authors found that the mortality of patients receiving a PEG followed that predicted for a similar cohort of patients without PEGs in the Levine model. This suggests that the deaths observed were due to underlying comorbidities, can provide a baseline for mortality targets for PEG services, and is useful patient information regarding the risks and benefits of the procedure. The findings demonstrate that PEG does no harm and supports the accepted opinion that nutrition support is associated with a better outcome. Furthermore, they show that most deaths occur within the first month of placement and would support arguments for delaying placement until outcome from the underlying condition is more predictable. (JPEN J Parenter Enteral Nutr. XXXX;XX:000-000)

First published on April 1, 2009, doi:10.1177/0148607108327156

Journal of Parenteral and Enteral Nutrition 2009;33:375.

A more recent version of this article appeared on July 1, 2009

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