Percutaneous endoscopic gastrostomy (PEG): change in practice since 1988.
OBJECTIVE
We previously reported a 30-day mortality following percutaneous endoscopic gastrostomy (PEG) of 8% (1988-92). Concerns over increasing mortality rates prompted us to survey current practice compared with 1988-92: assess case mix, outcome, risk factors for early death, and review practice guidelines.


METHODS
78 consecutive adults were referred for PEG over 7 months. Baseline characteristics, including age and functional status (Barthel Index), and outcome at 30 and 180 days were prospectively evaluated.


RESULTS
74 patients. Median age 69 years; male 55%. Major underlying diagnoses: cerebrovascular disease 42%, head and neck tumours 19%, motor neurone disease 4% (33%, 16% and 27% in 1988-92). Mortality rates at 30, 90 and 180 days were 19%, 35% and 42% respectively (8%, 20% and 37% in 1988-92). Univariate analysis showed that age >75 years, Barthel Index <1 and Glasgow Coma Scale < or =10 were significant risk factors for death at 30 days: odds ratios (95% confidence intervals) 3.9 (1.1-13), 5.9 (1.4-25) and 4.4 (1.2-15) respectively.


CONCLUSIONS
30-day mortality was increased from 8% to 19% between 1988-92 and 1998-99 reflecting a change in referral patterns: more elderly with cerebrovascular disease and fewer with motor neurone disease. Age and functional status should be considered when advising on PEG feeding.
Skelly
R H
RH
Southern Derbyshire Acute Hospitals NHS Trust, UK.
Kupfer
R M
RM
Metcalfe
M E
ME
Allison
S P
SP
Holt
M
M
Hull
M A
MA
Rawlings
J K
JK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000401:mortality*; D005260:Female; D005774:Gastrostomy / Q000401:mortality*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019636:Neurodegenerative Diseases / Q000601:surgery*; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome