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A prospective evaluation of outcome in patients referred for PEG placement
Kenji Kobayashi1, Gregory S Cooper, Amitabh Chak
1Division of Gastroenterology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio 44106-5066, USA.
Insights
High comorbidity, indicated by a Charlson index of 4 or greater, significantly predicts shorter survival after percutaneous endoscopic gastrostomy (PEG) feeding tube placement. This highlights the need for careful patient selection.
Area of Science:
- Gastroenterology
- Geriatrics
- Clinical Medicine
Background:
- Percutaneous endoscopic gastrostomy (PEG) placement carries a substantial 30-day mortality risk.
- PEG feeding is generally not recommended for short-term use due to this risk.
Purpose of the Study:
- To prospectively identify factors predicting survival in patients referred for PEG placement.
- To improve patient selection for PEG procedures.
Main Methods:
- Prospective study of patients referred for PEG placement.
- Data collected included demographics, Charlson comorbidity index, and functional status.
- Patients were followed for up to 12 months post-PEG placement.
Main Results:
- Of 50 patients who underwent PEG placement, 7-day and 30-day mortality rates were 4% and 20%, respectively.
- A Charlson comorbidity index of 4 or greater was significantly associated with decreased survival time (HR=2.9, P=0.019).
- Median survival was significantly shorter for patients with a Charlson index ≥4 compared to those with <4 (P=0.013).
Conclusions:
- A Charlson comorbidity index ≥4 is a significant predictor of reduced survival post-PEG consultation.
- Evaluating predictive survival factors is crucial for optimizing patient selection for PEG feeding.
Background:
PEG feeding is not recommended for short-term use because the 30-day mortality after PEG placement is substantial. The primary aim of this study was to prospectively identify factors predictive of survival in patients referred for PEG placement.
Methods:
All patients for whom gastroenterology consultation was sought for feeding PEG placement were prospectively studied. Demographic data, Charlson comorbidity index, and functional status were recorded at entry. After PEG placement, patients were followed for up to 12 months.
Results:
Of the 67 patients for whom consultation was requested, 58 were eligible for the study and 50 underwent PEG placement. The 7-day and 30-day mortality rates in the PEG placement group were 4% and 20%, respectively. In multivariate analysis, only the Charlson index > or =4 was associated with decreased survival time (relative hazard = 2.9: 95% CI [1.20, 7.21], p = 0.019). Median survival in patients with Charlson comorbidity index > or =4 was significantly shorter than that in patients with Charlson index < 4 (p = 0.013).
Conclusions:
A Charlson comorbidity index > or =4 was significantly associated with shorter patient survival after initial consultation. Careful consideration of predictive factors of survival may improve patient selection for feeding PEG placement.