Risk Factors and Natural History of Bedside Percutaneous Endoscopic Versus Fluoroscopic Guided Gastrostomy Tubes in Intensive Care Unit Patients

Document Type

Conference Proceeding

Publication Date

6-7-2023

Publication Title

Surg Endosc

Abstract

Introduction: There is a paucity of literature comparing patients receiving bedside placed percutaneous endoscopic gastrostomy (PEG) versus fluoroscopic guided percutaneous gastrostomy tubes (G-tube) in an intensive care unit (ICU) setting. This study aims to investigate and compare the natural history and complications associated with PEG versus fluoroscopic G-tube placement in ICU patients. Methods: All adult patients admitted in the ICU requiring feeding tube placement at our center from 1/1/2017 to 1/1/2022 were identified through retrospective chart review. Patients with at least 6-months follow-up were included in this study. Descriptive statistics were used to illustrate the cohort's natural history. Adjusting for patient comorbidities, hospital factors, and indications for enteral access, a 1-to-2 propensity score matched cox proportional hazards model was fitted evaluate the treatment effect of bedside PEG tube placement versus G-tube placement on patient complications, 6-month readmission, and 6-month death. Major complications were defined as the need for operative or procedural intervention. Results: This study included 740 patients, with 178 bedside PEG (mean age 59.9 [IQR: 47-68.3] years; 55.9% black race; 63.5% male sex) and 562 fluoroscopic G-tube (62.9 [IQR: 51.1-71.1] years; 42.6% black race; 58.5% male sex) placements. Indication for enteral access was predominantly trauma (23.7%) or respiratory (33.7%) in nature for PEG recipients and neurologic (59.6%) for G-tube recipients. The overall rate of complication was 22.3% (13% PEG, 25.2% G-tube, P = 0.003). The major complication rate was 11.2% (8.5% PEG, 12.1% G-tube, P = 0.09). Most common complications were tube dysfunction (16.7% PEG; 39.4% G-tube; p = 0.04) or dislodgement (58.3% PEG; 40.8% G-tube). The average hospital stay was 30.9 days (IQR: 22.3-45.3) for PEG and 24.7 days (IQR: 17.6-36.9) for G-tube recipients (P<0.001). 55.9% PEG and 45.7% G-tube recipients were discharged to long-term care whereas 5% PEG and 9.6% G-tube recipients were discharged home (p<0.001). After propensity score matching, G-tube recipients had significantly increased risk for all-cause (HR: 2.7, 95% C.I.: 1.56-4.87, P<0.001) and major complications (HR: 2.11, 95% C.I.: 1.05-4.23, P = 0.035). There were no significant differences in 6-month rates of readmission (HR: 0.90, 95% C.I.: 0.58-1.38, P = 0.62) or death (HR: 1.00, 95% C.I.: 0.70-1.44, P = 0.7). Conclusions: The overall rate of complications for ICU patients requiring feeding tube in our cohort was 22.3%. ICU patients receiving fluoroscopic guided percutaneous gastrostomy tube placement had significantly elevated risk of 6-month all-cause and major complications compared to those undergoing bedside percutaneous endoscopic gastrostomy. (Figure Presented).

Volume

37

First Page

S229

Last Page

S229

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