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Improving 30-day mortality after PEG tube placement in England from 2007 to 2019: a retrospective national cohort analysis of 87,862 patients
Gastrointestinal Endoscopy ( IF 7.7 ) Pub Date : 2022-07-05 , DOI: 10.1016/j.gie.2022.06.031
Umair Kamran 1 , Pui Chi Lee 1 , Ben Coupland 2 , Abdullah Abbasi 3 , Helen Steed 4 , Sissi Ispoglou 5 , Fumi Varyani 1 , Nigel Trudgill 1
Affiliation  

Background and Aims

PEG has been associated with poor case selection and high mortality. We examined indications, 30-day mortality, and 7-day adverse events in a national cohort undergoing PEG tube insertion.

Methods

Adult patients undergoing their first PEG tube insertion from 2007 to 2019 were identified in the Hospital Episode Statistics database. Indications and adverse events were identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes. Multivariable logistic regression modeling examined factors associated with mortality.

Results

Of 87,682 patients identified, 58% were men and median age was 69 years (interquartile range, 57-79). The number of patients with dementia or stroke as the indication for PEG fell from 2007 to 2019 (dementia, from 147 to 28 [P < .001]; stroke, from 2851 to 1781 [P < .001]). The median interval from stroke admission to PEG tube insertion increased from 21 (interquartile range, 12-36) to 28 (interquartile range, 13-45) days (P < .001). Aspiration pneumonia within 7 days of PEG fell from 10.2% to 8.6% (P = .04). Thirty-day mortality fell from 13.2% to 5.3% (P < .001), with associated factors of increasing age (≥82 years quintile odds ratio [OR], 4.44; 95% confidence interval [CI], 4.01-4.92), PEG tube insertion during emergency admission (OR, 2.10; 95% CI, 1.97-2.25), Charlson comorbidity score ≥5 (OR, 1.67; 95% CI, 1.53-1.82), and dementia (OR, 1.46; 95% CI, 1.26-1.71). Female sex (OR, .81; 95% CI, .77-.85), least-deprived quintile (OR, .88; 95% CI, .81-.95), and more recent years of PEG tube insertion (2019; OR, .44; 95% CI, .39-.51) were negatively associated with mortality.

Conclusions

Thirty-day mortality after PEG tube insertion has fallen 60% over 13 years. Dementia or stroke as an indication for PEG fell, and the time interval from stroke to PEG tube insertion increased. These findings may be attributable to improved patient selection and timing for PEG tube insertion.



中文翻译:

2007 年至 2019 年英格兰 PEG 管放置后 30 天死亡率的改善:对 87,862 名患者的回顾性全国队列分析

背景和目标

PEG 与病例选择不当和死亡率高有关。我们在接受 PEG 管插入的全国队列中检查了适应症、30 天死亡率和 7 天不良事件。

方法

在医院事件统计数据库中确定了 2007 年至 2019 年首次插入 PEG 管的成年患者。使用国际疾病和相关健康问题统计分类,第 10 次修订代码确定适应症和不良事件。多变量逻辑回归模型检查了与死亡率相关的因素。

结果

在确定的 87,682 名患者中,58% 为男性,中位年龄为 69 岁(四分位间距,57-79)。从 2007 年到 2019 年,以 PEG 为适应症的痴呆症或中风患者人数有所下降(痴呆症从 147 人减少到 28 人 [ P  < .001];中风从 2851 人减少到 1781 人 [ P  < .001])。从卒中入院到插入 PEG 管的中位间隔时间从 21(四分位距,12-36)天增加到 28(四分位距,13-45)天(P  < .001)。PEG 后 7 天内吸入性肺炎的发生率从 10.2% 下降到 8.6% ( P  = .04)。30 天死亡率从 13.2% 下降到 5.3% ( P < .001),伴随年龄增加的相关因素(≥82 岁五分位数比值比 [OR],4.44;95% 置信区间 [CI],4.01-4.92),紧急入院时插入 PEG 管(OR,2.10;95% CI,1.97-2.25)、Charlson 合并症评分≥5(OR,1.67;95% CI,1.53-1.82)和痴呆(OR,1.46;95% CI,1.26-1.71)。女性(OR,0.81;95% CI,0.77-0.85),最贫困的五分位数(OR,0.88;95% CI,0.81-0.95),以及最近几年的 PEG 管插入(2019 年) ; OR, .44; 95% CI, .39-.51) 与死亡率呈负相关。

结论

PEG 管插入后的 30 天死亡率在 13 年内下降了 60%。痴呆症或中风作为 PEG 的指征下降,并且从中风到 PEG 管插入的时间间隔增加。这些发现可能归因于患者选择和 PEG 管插入时间的改进。

更新日期:2022-07-05
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