title: Assessment of indications for percutaneous endoscopic gastrostomy--development of a predictive model.
abstract: OBJECTIVE
  Percutaneous endoscopic gastrostomy (PEG) is used for long-term enteral nutrition in neurological patients with dysphagia (NEUR), in head and neck cancer patients prior to chemoradiation therapy (head and neck malignancy group [HNM]), or in cases of oropharyngeal or esophageal tumor obstruction or stricture (OBSTR). Considerable morbidity and overall mortality is reported. Aim was to analyze the complication rates and mortality with PEG and to identify subgroups with poor outcomes.
  
  
  METHODS
  Patients underwent PEG (n = 401) in a single tertiary care center. Indications, characteristics, and causes of death were recorded.
  
  
  RESULTS
  Number of patients in groups: HNM 135 (34%), OBSTR 74 (18%), and NEUR 192 (48%); follow-up time median (interquartile range): 17 (39) months; the time PEG used for feeding: 4 (7) months. A total of 91 patients (23%) had 110 complications, 31 patients (8%) had early (≤30 days) complications, and 49 patients (12%) major complications. Two deaths (0.5%, 2 peritonitis) were related to PEG. The 30-day mortality was 11% (n = 47). According to multivariate analysis, an increased 30-day mortality was associated with ≥75 years of age, American Society of Anesthesiologists (ASA) class IV, a Charlson comorbidity index (CCI) ≥4, body mass index (BMI) <18.5, and ongoing antibiotic therapy. With this model, 95% specificity was obtained in the 30-day survival figures.
  
  
  CONCLUSIONS
  The presented predictive model derived from our analysis may recognize patients with poor outcome when referred for PEG. The parameters in the present model (age, ASA class, CCI score, BMI, and data of ongoing antibiotic treatment) are easily measurable, and it is possible to integrate them into everyday work.
authors.affiliation: Department of Gastroenterological and General Surgery, Unit of Therapeutic Endoscopy, Helsinki University Central Hospital and Helsinki University , Helsinki , Finland.
authors.forename: Marianne
authors.initials: M
authors.lastname: Udd
authors.forename: Outi
authors.initials: O
authors.lastname: Lindström
authors.forename: Harri
authors.initials: H
authors.lastname: Mustonen
authors.forename: Leif
authors.initials: L
authors.lastname: Bäck
authors.forename: Jorma
authors.initials: J
authors.lastname: Halttunen
authors.forename: Leena
authors.initials: L
authors.lastname: Kylänpää
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002423:Cause of Death; D003644:Death Certificates; D003661:Decision Support Techniques; D003680:Deglutition Disorders / Q000628:therapy; D004750:Enteral Nutrition / Q000401:mortality; D005260:Female; D005387:Finland; D005774:Gastrostomy / Q000401:mortality*; D006258:Head and Neck Neoplasms / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors
keywords: comorbidity; death certificates; dysphagia; enteral nutrition; gastrostomy; intraoperative complications mortality; postoperative complications