title: Long-term outcome after percutaneous endoscopic gastrostomy in geriatric Mexican patients.
abstract: OBJECTIVE
  To evaluate long-term survival and prognostic factors in elderly Mexican patients who have undergone percutaneous endoscopic gastrostomy (PEG).
  
  
  METHODS
  The present study was a retrospective cohort analysis of 110 patients aged older than 70 years without head and neck malignancy who underwent PEG between January 2005 and December 2012. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for demographic and clinical variables, and survival was determined by the Kaplan-Meier method.
  
  
  RESULTS
  Medium age and follow up were 82.45 ± 6.6 years and 688.3 ± 394.6 days, respectively. The patients who died in the early postoperative period (n = 6) were older than those who survived. The Karnofsky performance status and lymphocyte count were non-significantly lower in non-survivors. The body mass index and serum albumin level were lower in non-survivors (P = 0.03 and 0.01, respectively) and Charlson's Comorbidity Index (CCI) was higher. A total of 32 (29%) patients died later in the postoperative period with a mean follow up of 436.2 ± 267.4 days. Risk factors for mortality included Karnofsky Performance Status (odds ratio [OR] 9.76, 95% CI: 3.26-29.3), CCI (OR 7.04, 95% CI: 2.31-21.41) and postoperative hypoalbuminemia (OR 3.45, 95% CI: 1.71-6.67). Postgastrostomy pneumonia occurred in 36.8% of the patients who died during follow-up (OR 0.28, 95% CI: 0.6-1.26).
  
  
  CONCLUSIONS
  Karnofsky performance status, Charlson's comorbidity index and postoperative hypoalbuminemia, were independent risk factors for mortality. Modifiable factors are related to nutritional support. Early PEG may help prevent malnutrition and infection.
authors.affiliation: Research Unit in Clinical Epidemiology, Specialties Hospital of the Western Medical Center, Medical Unit of High Specialty, Mexican Institute of Social Security, Guadalajara, Mexico.
authors.forename: Ana Olivia
authors.initials: AO
authors.lastname: Cortés-Flores
authors.forename: Andrea del Socorro
authors.initials: Adel S
authors.lastname: Álvarez-Villaseñor
authors.forename: Clotilde
authors.initials: C
authors.lastname: Fuentes-Orozco
authors.forename: Kenia Militzi
authors.initials: KM
authors.lastname: Ramírez-Campos
authors.forename: Anais del Roció
authors.initials: Adel R
authors.lastname: Ramírez-Arce
authors.forename: Michel Dassaejv
authors.initials: MD
authors.lastname: Macías-Amezcua
authors.forename: Mariana
authors.initials: M
authors.lastname: Chávez-Tostado
authors.forename: Joel Sealtiel
authors.initials: JS
authors.lastname: Hernández-Machuca
authors.forename: Alejandro
authors.initials: A
authors.lastname: González-Ojeda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000401:mortality / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005774:Gastrostomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: gastrostomy; hypoalbuminemia; morbidity; mortality; pneumonia