title: Factors predictive of survival after percutaneous endoscopic gastrostomy in the elderly: is dementia really a risk factor?
abstract: OBJECTIVE
  Outcomes, especially survival, after percutaneous endoscopic gastrostomy (PEG) in patients with dementia remain unclear. The aims of this study were to assess the impact of dementia on survival after PEG and to explore the risk factors in elderly patients.
  
  
  METHODS
  A total of 311 consecutive Japanese patients who underwent PEG were enrolled in this retrospective cohort study. Dementia was defined according to the standard criteria. After the clinical characteristics of patients with and without dementia were compared, the Kaplan-Meier method and Cox proportional-hazards regression analysis were applied to analyze survival rates.
  
  
  RESULTS
  Survival was not significantly different between the two groups. The 12-month survival rate of patients with dementia (N = 143) was 51%, and that of patients without dementia (N = 168) was 49%. More than 20% of patients with dementia lived more than 3 yr after PEG. The predictors of poor survival after PEG were previous subtotal gastrectomy (odds ratio [OR] 2.619, 95% confidence interval [CI] 1.367-5.019), serum albumin <2.8 g/dL (OR 2.081, 95% CI 1.490-2.905), age >80 yr (OR 1.721, 95% CI 1.234-2.399), chronic heart failure (OR 1.541, 95% CI 1.096-2.168), and male gender (OR 1.407, 95% CI 1.037-1.909).
  
  
  CONCLUSIONS
  In our series, there was no evidence to support a poorer prognosis after PEG in elderly people with dementia compared with the cognitively preserved elderly. However, if patients are male or of advanced age, have a low serum albumin, chronic heart failure, or subtotal gastrectomy, physicians should inform families that a poor prognosis is expected before performing PEG.
authors.affiliation: Department of Surgery, Tottori Municipal Hospital, Matoba, Tottori, Japan.
authors.forename: Fumiyo
authors.initials: F
authors.lastname: Higaki
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokota
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ohishi
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003704:Dementia; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005774:Gastrostomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate