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Safety of Percutaneous Endoscopic Gastrostomy Tube Placements by Interventional Pulmonologists
Procedures SESSION TITLE: Interventional Pulmonary Procedural Safety and Outcomes SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, October 26, 2016 at 02:45 PM - 04:15 PM
Safety of Percutaneous Endoscopic Gastrostomy Tube Placements by Interventional Pulmonologists Kurt Olson MD Taaran Cariappa Ballachanda Subbaiah MD* Rajeev Saggar MD; and Richard Sue MD St. Joseph’s Hospital and Medical Center, Phoenix, AZ PURPOSE: To evaluate the safety of percutaneous endoscopic gastrostomy (PEG) tube placements by interventional pulmonologists (IPs) METHODS: We performed a retrospective study of 265 PEG tube placements performed by interventional pulmonologists at a single center in the inpatient and outpatient settings. Patient charts were reviewed using the electronic medical record system. Consistent with current PEG tube placement literature, complications were categorized as either major or minor. Major complications were defined as procedure related deaths and any complication that required an additional procedure or surgery or the use of non-prophylactic antibiotics or blood transfusions. Minor complications were defined as all other complications. We measured incidence rates for both major and minor complications; data was also collected on 30 day mortality, length of hospital stay and length of ICU stay. Information was collected to assess patient characteristics, comorbidities, reasons to undergo the procedure, prophylactic antibiotics used and the duration prior to procedure that anticoagulation was held. RESULTS: The median age for our study population was 61 years and the median BMI was 27.2 kg/m2. Of the 265 procedures included in our study, 29.8% were combined PEG tube and percutaneous dilational tracheostomy (PDT) placements, 66.8% were PEG tube placements and 3.4% were PEG tube replacements. There were no procedure related mortalities. 16 cases were not completed successfully. The incidence of major complications was 2.8%, minor complications was 5.2% and 30 day mortality was 6%. CONCLUSIONS: This is the largest series of PEG tube placements performed by IPs ever recorded. When we compared our results to published literature on PEG tube placements by multiple medical and surgical specialties, we found that our study showed very comparable incidence rates for major and minor complications. Our results further that this procedure can also be safely performed by IPs.
DISCLOSURE: The following authors have nothing to disclose: Kurt Olson, Taaran Cariappa Ballachanda Subbaiah, Rajeev Saggar, Richard Sue No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.1107
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
1001A
PROCEDURES
CLINICAL IMPLICATIONS: We believe our IPs’ greater than 10 years of experience with performing this procedure has demonstrated that they can do it safely while at bedside in ICU and at the time of PDT if required. Additionally, because IPs manage the major complications related to this procedure, they are better equipped to assess appropriate patient selection. This reduces the burden on procedure rooms and anesthesiologists, resulting in a decreased cost of performing the procedure itself, thus decreasing health care costs and improving health care indices.
Safety of Percutaneous Endoscopic Gastrostomy Tube Placements by Interventional Pulmonologists Kurt Olson MD Taaran Cariappa Ballachanda Subbaiah MD* Rajeev Saggar MD; and Richard Sue MD St. Joseph’s Hospital and Medical Center, Phoenix, AZ PURPOSE: To evaluate the safety of percutaneous endoscopic gastrostomy (PEG) tube placements by interventional pulmonologists (IPs) METHODS: We performed a retrospective study of 265 PEG tube placements performed by interventional pulmonologists at a single center in the inpatient and outpatient settings. Patient charts were reviewed using the electronic medical record system. Consistent with current PEG tube placement literature, complications were categorized as either major or minor. Major complications were defined as procedure related deaths and any complication that required an additional procedure or surgery or the use of non-prophylactic antibiotics or blood transfusions. Minor complications were defined as all other complications. We measured incidence rates for both major and minor complications; data was also collected on 30 day mortality, length of hospital stay and length of ICU stay. Information was collected to assess patient characteristics, comorbidities, reasons to undergo the procedure, prophylactic antibiotics used and the duration prior to procedure that anticoagulation was held. RESULTS: The median age for our study population was 61 years and the median BMI was 27.2 kg/m2. Of the 265 procedures included in our study, 29.8% were combined PEG tube and percutaneous dilational tracheostomy (PDT) placements, 66.8% were PEG tube placements and 3.4% were PEG tube replacements. There were no procedure related mortalities. 16 cases were not completed successfully. The incidence of major complications was 2.8%, minor complications was 5.2% and 30 day mortality was 6%. CONCLUSIONS: This is the largest series of PEG tube placements performed by IPs ever recorded. When we compared our results to published literature on PEG tube placements by multiple medical and surgical specialties, we found that our study showed very comparable incidence rates for major and minor complications. Our results further that this procedure can also be safely performed by IPs.
DISCLOSURE: The following authors have nothing to disclose: Kurt Olson, Taaran Cariappa Ballachanda Subbaiah, Rajeev Saggar, Richard Sue No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.1107
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
1001A
PROCEDURES
CLINICAL IMPLICATIONS: We believe our IPs’ greater than 10 years of experience with performing this procedure has demonstrated that they can do it safely while at bedside in ICU and at the time of PDT if required. Additionally, because IPs manage the major complications related to this procedure, they are better equipped to assess appropriate patient selection. This reduces the burden on procedure rooms and anesthesiologists, resulting in a decreased cost of performing the procedure itself, thus decreasing health care costs and improving health care indices.