title: High In-hospital mortality after percutaneous endoscopic gastrostomy: results of a nationwide population-based study.
abstract: OBJECTIVE
  It is important to carefully select patients who undergo endoscopic procedures, to optimize health care. Percutaneous endoscopic gastrostomy (PEG) is a frequently performed invasive endoscopic procedure that has been associated with high short-term mortality. We used a national database to determine the incidence of, and factors associated with, in-hospital mortality among patients undergoing PEG.
  
  
  METHODS
  We conducted a nested, case-control, retrospective study using the US Nationwide Inpatient Sample (NIS) to analyze data from all hospitalizations in 2006 with an International Classification of Diseases, 9th revision, procedure code for PEG. Bivariate and multivariate logistic regression analyses were performed using demographic and clinical variables to identify predictors of in-hospital mortality after the procedure. A separate analysis using a propensity score matching technique was conducted to compare mortality with a control cohort. Results were validated in an independent analysis of 2007 NIS data.
  
  
  RESULTS
  In-hospital mortality was 10.8% among 181,196 patients who underwent PEG in 2006 (95% confidence interval, 10.3%-11.3%). Odds of death increased with age (1%/y), congestive heart failure, renal failure, chronic pulmonary disease, coagulopathy, pulmonary circulation disorders, metastatic cancer, and liver disease. The indication for PEG was associated strongly with mortality. Women and patients with diabetes mellitus or paralysis had a lower risk of death. PEG was associated with slightly higher odds of in-hospital mortality compared with patients who did not undergo PEG. Qualitatively and quantitatively similar results were obtained when 2007 NIS data were analyzed.
  
  
  CONCLUSIONS
  The mortality rate is almost 11% among hospital inpatients after PEG. We have identified factors that increase and decrease the risk of death after PEG; these factors could improve patient selection for those most likely to benefit from this procedure.
authors.affiliation: Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: gaurav.arora@utsouthwestern.edu.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Arora
authors.forename: Don
authors.initials: D
authors.lastname: Rockey
authors.forename: Samir
authors.initials: S
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D055815:Young Adult
keywords: CI; Complication; Enteral Access for Feeding; ICD-9 CM; International Classification of Diseases, 9th revision, clinical modification; NIS; National Priorities Partnership; Nationwide Inpatient Sample; PEG; PSM; Risk Factor; confidence interval; percutaneous endoscopic gastrostomy; propensity score matching