title: Contemporary acute care surgery percutaneous endoscopic gastrostomy tube placement: an extreme bumper height and complications.
abstract: BACKGROUND
  As the role of acute care surgery (ACS) becomes more prevalent, clinicians in this specialty will be placing more percutaneous endoscopic gastrostomy (PEG) tubes. In this contemporary series of ACS PEG procedures, we hypothesized that technical aspects of PEG tube placement may play an important role.
  
  
  METHODS
  For our retrospective study, we queried our tertiary Level I trauma center's prospectively maintained ACS database for PEG tube placement. Our study period was from July 1, 2010, through June 30, 2012. We excluded patients who underwent "push" PEG placement, an outpatient PEG tube placement, or an open or laparoscopic gastrostomy tube operation. We conducted a multivariate logistic regression analysis of factors contributing to complications.
  
  
  RESULTS
  During our 24-month study period, of 184 patients, 133 underwent "pull" PEG tube placement with sufficient data for analysis. The mean (SD) age was 56 (22) years; 66% were male. Overall, 33 (25%) experienced complications: 13 (10%) were major and 20 (15%) were minor complications. In our multivariate logistic regression analysis, we found that an extreme bumper height (<2 or >5 cm) (odds ratio, 1.57; 95% confidence interval, 1.14-2.16) and upper aerodigestive tract malignancy as the operative indication (odds ratio, 1.54; 95% confidence interval, 1.06-2.26) were significantly associated with complications.
  
  
  CONCLUSIONS
  Although pull PEG tube placement is typically a straightforward procedure, morbidity can be significant. Bumper height is an easily modifiable variable; obtaining the proper height for each patient could decrease complications after PEG tube placement.
  
  
  METHODS
  Therapeutic study, level IV.
authors.affiliation: From the Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Glazer
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Green
authors.forename: Lynn
authors.initials: L
authors.lastname: Gries
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Tang
authors.forename: Julie L
authors.initials: JL
authors.lastname: Wynne
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rhee
mesh_terms: D001130:Arizona / Q000453:epidemiology; D004632:Emergency Medical Services / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors