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Does Prior Abdominal Surgery Increase the Incidence of Adverse Events following Percutaneous Endoscopic Gastrostomy Tube Placement?
Sa1987
AGA Abstracts
DOES PRIOR ABDOMINAL SURGERY INCREASE THE INCIDENCE OF ADVERSE EVENTS FOLLOWING PERCUTANEOUS ENDOSCOPIC GASTROSTOMY TUBE PLACEMENT? Tomas DaVee, Samreen Khuwaja, Aman Deep, Selvi Thirumurthi, Graciela M. NoguerasGonzález, Phillip Lum, Manoop S. Bhutani, Ethan Miller, Jeffrey Lee Introduction Prior abdominal surgery has been reported to increase adverse events associated with surgical procedures. The effect of prior abdominal surgery on the incidence of adverse events following percutaneous endoscopic gastrostomy (PEG) tube placement is not well defined. The objective of this study was to compare the incidence of adverse event following PEG tube placement in patients with and without prior abdominal surgeries. Methods Adult patients who underwent placement of a transoral PEG tube for any indication were retrospectively identified from an institutional database over a 12 month time period. Data related to prior abdominal surgeries and adverse events, both early and late, were collected. Patients were divided in two groups - with or without previous abdominal surgeries. The incidence of adverse events was compared for these two groups. Results Among 215 total patients in the cohort, 26% (56/215) of PEG tube placements were performed in patients who had undergone prior abdominal surgeries. Median age was 65 years and 74.9% (161/ 215) of cases were male. The most common indication for PEG placement was head and neck cancer 81.9% (176). Prior abdominal surgeries included: appendectomy (62.5%), cholecystectomy (32.1 %), partial colectomy (4, 7.1%). The incidence of adverse events following PEG tube placement was 7.1% (4/56) in patients with prior abdominal surgeries compared to 6.3% (10/159) without abdominal surgical history. Analysis revealed that subjects with prior abdominal surgeries were not at increased risk of adverse events following PEG tube placement compared to patients with no prior history of abdominal surgeries (P= 0.762). Four adverse events were noted in patients with prior abdominal surgeries: 3 of those patients had an gastro-cutaneous fistula formation following PEG tube removal and one recurrent leakage around PEG tube site. Out of ten patients without prior abdominal surgeries who suffered adverse events, 3 developed peristomal cellulitis, 2 internal hemorrhage, and 1 aspiration; while 3 developed gastro-cutaneous fistula and one buried bumper syndrome. There were no cases of tumor-seeding at the gastrostomy site. Conclusion Patients with prior abdominal surgeries do not have a significantly higher risk of adverse events compared to other patients undergoing PEG tube placements in this study. Therefore, prior abdominal surgery should not preclude safe PEG tube placement.
Figure 1. Cumulative survival rate between NST intervention and no intervention group
Sa1989 INPATIENT TREND ANALYSIS OF MECHANICAL COMPLICATION OF GASTROSTOMY Khwaja F. Haq, Shantanu Solanki, Muhammad Ali Khan, Shalom Frager, Sachin Sule, Edward Lebovics Introduction Gastrostomy tube is the preferred modality for long term nutritional support in patients with inadequate oral intake or those who cannot feed orally. Enteral feeding is preferred over intravenous route due to lower complications, lower cost, and ongoing enteral stimulation leading to maintenance of gut defense barrier. However, gastrostomy is associated with its own problems, mechanical complication being one of the most common. Limited data exists on the annual number of hospitalizations, mean length of stay (LOS), inpatient mortality, and cost of care associated with mechanical complication of gastrostomy. Methods We analyzed the National Inpatient Sample (NIS) database for all subjects with discharge diagnosis of mechanical complications of gastrostomy (ICD-9 code 536.42) as primary or secondary diagnosis from 2001-2011, and the number of gastrostomy procedures performed (ICD-9 CPT code 43.11 and 43.19). For all hospitalizations with discharge diagnosis of mechanical complications of gastrostomy, inpatient mortality, mean length of stay and cost per admission were analyzed. NIS is the largest publicly available all-payer inpatient care database in the US containing data from approximately 8 million hospital stays each year. Statistical significance of variation in the number of hospital discharges, inpatient mortality, mean LOS, and cost of care was determined using Cochran-Armitage trend test. Results In 2001, there were 3,580 hospitalizations with discharge diagnosis of mechanical complication of gastrostomy as compared to 4,054 in 2011 (p<0.0001). Number of gastrostomy procedures recorded in 2001 was 219,940 as compared to 217,905 in 2011 with slight increase in overall trend from 2001 to 2011 (p<0.0001, figure 1A). Although there was an increase in the number of discharges with mechanical complication of gastrostomy from 1.63% in 2001 to 1.86% 2011 (p<0.0001, figure 1B), there was an overall decrease in the trend for inpatient mortality (p=0.0019, figure 1C). Mean LOS increased from 19.00 days in 2001 to 24.15 days in 2011 (p<0.0001, figure 1D). Cost per hospitalization showed an increase from $36,514 in 2001 (adjusted for inflation) to $56,263 in 2011 (p<0.0001, figure 2). Discussion This study shows significant increase in the annual number of hospitalizations with mechanical complication of gastrostomy with slight increase in overall trend for the total number of procedures performed. Overall, inpatient mortality associated with mechanical complication of gastrostomy decreased but mean LOS and cost per hospitalization both increased significantly. These trends are suggestive of higher incidence with improved outcomes but at a higher cost of care. Further studies are needed to identify factors responsible for such outcomes as well as predictors of increasing number of hospitalizations with mechanical complication of gastrostomy.
Sa1988 IMPACT AND OUTCOMES OF NUTRITIONAL SUPPORT TEAM INTERVENTION IN PATIENTS WITH GASTROINTESTINAL DISEASE IN THE INTENSIVE CARE UNIT Yong Eun Park, Hyun Jung Lee, Sung Pil Hong, Jae Hee Cheon, Tae Il Kim, Won Ho Kim, Soo Jung Park Background: Nutrition support (NS) has become an important intervention for critically ill patients. Many studies have reported on the effects of nutritional support with the patients within the intensive care unit (ICU); however, there are currently no studies that focused on the gastrointestinal patients in ICU. Methods: Ninety patients with gastrointestinal disease were enrolled in ICU between August 2014 and August 2016 at Severance hospital, Seoul, Korea. We analyzed two different patient groups; those who received nutritional support team (NST) intervention and those without NST intervention. Results: 56 patients (62.2%) received nutritional support in ICU and 34 patients (37.8%) did not. Variables including high albumin levels at ICU admission, high prealbumin levels, prolonged hospital stay, presence of GI bleeding at ICU admission, and NST intervention showed statistically significant association with lower mortality on the univariate analysis (all P<0.05). After the multivariate analysis, factors including high albumin levels at ICU (P=0.003; hazard ratio [HR], 0.363; 95% confidence interval [CI], 0.186-0.707), high prealbumin levels (P=0.017; HR, 0.991; 95% CI, 0.983-0.998), GI bleeding patients (P=0.002; HR, 0.294; 95% CI, 0.135-0.640), and NST intervention (P=0.045; HR, 0.519; 95% CI, 0.274-0.985) were determined to be the independent prognostic factors for mortality. In addition, cumulative survival rate of GI patients in ICU were significantly higher in the NST group compared with no intervention group (P=0.004, log-rank test). Conclusion: NST intervention was the independent prognostic factors for mortality in patient with gastrointestinal disease in ICU. Relative risk of mortality
Figure 1
S-417
AGA Abstracts
AGA Abstracts
DOES PRIOR ABDOMINAL SURGERY INCREASE THE INCIDENCE OF ADVERSE EVENTS FOLLOWING PERCUTANEOUS ENDOSCOPIC GASTROSTOMY TUBE PLACEMENT? Tomas DaVee, Samreen Khuwaja, Aman Deep, Selvi Thirumurthi, Graciela M. NoguerasGonzález, Phillip Lum, Manoop S. Bhutani, Ethan Miller, Jeffrey Lee Introduction Prior abdominal surgery has been reported to increase adverse events associated with surgical procedures. The effect of prior abdominal surgery on the incidence of adverse events following percutaneous endoscopic gastrostomy (PEG) tube placement is not well defined. The objective of this study was to compare the incidence of adverse event following PEG tube placement in patients with and without prior abdominal surgeries. Methods Adult patients who underwent placement of a transoral PEG tube for any indication were retrospectively identified from an institutional database over a 12 month time period. Data related to prior abdominal surgeries and adverse events, both early and late, were collected. Patients were divided in two groups - with or without previous abdominal surgeries. The incidence of adverse events was compared for these two groups. Results Among 215 total patients in the cohort, 26% (56/215) of PEG tube placements were performed in patients who had undergone prior abdominal surgeries. Median age was 65 years and 74.9% (161/ 215) of cases were male. The most common indication for PEG placement was head and neck cancer 81.9% (176). Prior abdominal surgeries included: appendectomy (62.5%), cholecystectomy (32.1 %), partial colectomy (4, 7.1%). The incidence of adverse events following PEG tube placement was 7.1% (4/56) in patients with prior abdominal surgeries compared to 6.3% (10/159) without abdominal surgical history. Analysis revealed that subjects with prior abdominal surgeries were not at increased risk of adverse events following PEG tube placement compared to patients with no prior history of abdominal surgeries (P= 0.762). Four adverse events were noted in patients with prior abdominal surgeries: 3 of those patients had an gastro-cutaneous fistula formation following PEG tube removal and one recurrent leakage around PEG tube site. Out of ten patients without prior abdominal surgeries who suffered adverse events, 3 developed peristomal cellulitis, 2 internal hemorrhage, and 1 aspiration; while 3 developed gastro-cutaneous fistula and one buried bumper syndrome. There were no cases of tumor-seeding at the gastrostomy site. Conclusion Patients with prior abdominal surgeries do not have a significantly higher risk of adverse events compared to other patients undergoing PEG tube placements in this study. Therefore, prior abdominal surgery should not preclude safe PEG tube placement.
Figure 1. Cumulative survival rate between NST intervention and no intervention group
Sa1989 INPATIENT TREND ANALYSIS OF MECHANICAL COMPLICATION OF GASTROSTOMY Khwaja F. Haq, Shantanu Solanki, Muhammad Ali Khan, Shalom Frager, Sachin Sule, Edward Lebovics Introduction Gastrostomy tube is the preferred modality for long term nutritional support in patients with inadequate oral intake or those who cannot feed orally. Enteral feeding is preferred over intravenous route due to lower complications, lower cost, and ongoing enteral stimulation leading to maintenance of gut defense barrier. However, gastrostomy is associated with its own problems, mechanical complication being one of the most common. Limited data exists on the annual number of hospitalizations, mean length of stay (LOS), inpatient mortality, and cost of care associated with mechanical complication of gastrostomy. Methods We analyzed the National Inpatient Sample (NIS) database for all subjects with discharge diagnosis of mechanical complications of gastrostomy (ICD-9 code 536.42) as primary or secondary diagnosis from 2001-2011, and the number of gastrostomy procedures performed (ICD-9 CPT code 43.11 and 43.19). For all hospitalizations with discharge diagnosis of mechanical complications of gastrostomy, inpatient mortality, mean length of stay and cost per admission were analyzed. NIS is the largest publicly available all-payer inpatient care database in the US containing data from approximately 8 million hospital stays each year. Statistical significance of variation in the number of hospital discharges, inpatient mortality, mean LOS, and cost of care was determined using Cochran-Armitage trend test. Results In 2001, there were 3,580 hospitalizations with discharge diagnosis of mechanical complication of gastrostomy as compared to 4,054 in 2011 (p<0.0001). Number of gastrostomy procedures recorded in 2001 was 219,940 as compared to 217,905 in 2011 with slight increase in overall trend from 2001 to 2011 (p<0.0001, figure 1A). Although there was an increase in the number of discharges with mechanical complication of gastrostomy from 1.63% in 2001 to 1.86% 2011 (p<0.0001, figure 1B), there was an overall decrease in the trend for inpatient mortality (p=0.0019, figure 1C). Mean LOS increased from 19.00 days in 2001 to 24.15 days in 2011 (p<0.0001, figure 1D). Cost per hospitalization showed an increase from $36,514 in 2001 (adjusted for inflation) to $56,263 in 2011 (p<0.0001, figure 2). Discussion This study shows significant increase in the annual number of hospitalizations with mechanical complication of gastrostomy with slight increase in overall trend for the total number of procedures performed. Overall, inpatient mortality associated with mechanical complication of gastrostomy decreased but mean LOS and cost per hospitalization both increased significantly. These trends are suggestive of higher incidence with improved outcomes but at a higher cost of care. Further studies are needed to identify factors responsible for such outcomes as well as predictors of increasing number of hospitalizations with mechanical complication of gastrostomy.
Sa1988 IMPACT AND OUTCOMES OF NUTRITIONAL SUPPORT TEAM INTERVENTION IN PATIENTS WITH GASTROINTESTINAL DISEASE IN THE INTENSIVE CARE UNIT Yong Eun Park, Hyun Jung Lee, Sung Pil Hong, Jae Hee Cheon, Tae Il Kim, Won Ho Kim, Soo Jung Park Background: Nutrition support (NS) has become an important intervention for critically ill patients. Many studies have reported on the effects of nutritional support with the patients within the intensive care unit (ICU); however, there are currently no studies that focused on the gastrointestinal patients in ICU. Methods: Ninety patients with gastrointestinal disease were enrolled in ICU between August 2014 and August 2016 at Severance hospital, Seoul, Korea. We analyzed two different patient groups; those who received nutritional support team (NST) intervention and those without NST intervention. Results: 56 patients (62.2%) received nutritional support in ICU and 34 patients (37.8%) did not. Variables including high albumin levels at ICU admission, high prealbumin levels, prolonged hospital stay, presence of GI bleeding at ICU admission, and NST intervention showed statistically significant association with lower mortality on the univariate analysis (all P<0.05). After the multivariate analysis, factors including high albumin levels at ICU (P=0.003; hazard ratio [HR], 0.363; 95% confidence interval [CI], 0.186-0.707), high prealbumin levels (P=0.017; HR, 0.991; 95% CI, 0.983-0.998), GI bleeding patients (P=0.002; HR, 0.294; 95% CI, 0.135-0.640), and NST intervention (P=0.045; HR, 0.519; 95% CI, 0.274-0.985) were determined to be the independent prognostic factors for mortality. In addition, cumulative survival rate of GI patients in ICU were significantly higher in the NST group compared with no intervention group (P=0.004, log-rank test). Conclusion: NST intervention was the independent prognostic factors for mortality in patient with gastrointestinal disease in ICU. Relative risk of mortality
Figure 1
S-417
AGA Abstracts