title: Prevalence and Predictors of Gastrostomy Tube and Tracheostomy Placement in Anoxic/Hypoxic Ischemic Encephalopathic Survivors of In-Hospital Cardiopulmonary Resuscitation in the United States.
abstract: BACKGROUND
  Current prevalence estimates of gastrostomy tube (GT)/tracheostomy placement in hospitalized patients with anoxic/hypoxic ischemic encephalopathic injury (AHIE) post cardiopulmonary resuscitation (CPR) are unknown. We sought, to estimate the prevalence of AHIE in hospitalized patients who had CPR and to identify patient/hospital level factors that predict the performance of GT/tracheostomy in those with AHIE.
  
  
  METHODS
  We performed a retrospective analysis of the Nationwide Inpatient Sample (years 2004-2010). All patients who developed AHIE following CPR were included. In this cohort the odds of having GT and tracheostomy was computed by multivariable logistic regression analysis. Patient and hospital level factors were the independent variables.
  
  
  RESULTS
  During the study period, a total of 686,578 CPR events occurred in hospitalized patients. Of these, 94,336 (13.7%) patients developed AHIE. In this AHIE cohort, 6.8% received GT and 8.3% tracheostomy. When compared to the 40-49 yrs age group, those aged >70 yrs were associated with lower odds for GT (OR = 0.65, 95% CI:0.53-0.80, p<0.0001). Those aged <18 years & those >60 years were associated with lower odds for having tracheostomy when compared to the 40-49 years group (p<0.0001). Each one unit increase in co-morbid burden was associated with higher odds for having GT (OR = 1.23,p<0.0001) or tracheostomy (OR = 1.17, p<0.0001). Blacks, Hispanics, Asians/Pacific Islanders, and other races were associated with higher odds for having GT or tracheostomy when compared to whites (p<0.05). Hospitals located in northeastern regions were associated with higher odds for performing GT (OR = 1.48, p<0.0001) or tracheostomy (OR = 1.63, p<0.0001) when compared to those in Western regions. Teaching hospitals (TH) were associated with higher odds for performing tracheostomy when compared to non-TH (OR = 1.36, 1.20-1.54, p<0.0001).
  
  
  CONCLUSIONS
  AHIE injury occurs in a significant number of in-hospital arrests requiring CPR. Certain predictors of GT/ Tracheostomy placement are identified. Patients in teaching hospitals were more likely to receive tracheostomy than their counterparts.
authors.affiliation: UH Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Veerajalandhar
authors.initials: V
authors.lastname: Allareddy
authors.affiliation: University of Nebraska, Health Services and Research department, Omaha, Nebraska, United States of America.
authors.forename: Sankeerth
authors.initials: S
authors.lastname: Rampa
authors.affiliation: University of Michigan, College of Dentistry, Ann Arbor, Michigan, United States of America.
authors.forename: Romesh P
authors.initials: RP
authors.lastname: Nalliah
authors.affiliation: UH Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Natalia I
authors.initials: NI
authors.lastname: Martinez-Schlurmann
authors.affiliation: UH Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Lidsky
authors.affiliation: University of Iowa, School of Dentistry, College of Dentistry and Dental Clinics, Iowa City, Iowa, United States of America.
authors.forename: Veerasathpurush
authors.initials: V
authors.lastname: Allareddy
authors.affiliation: UH Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Alexandre T
authors.initials: AT
authors.lastname: Rotta
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000628:therapy*; D016887:Cardiopulmonary Resuscitation; D005260:Female; D005774:Gastrostomy; D006761:Hospitals; D006801:Humans; D002534:Hypoxia, Brain / Q000150:complications* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D017741:Survivors; D014139:Tracheostomy; D014481:United States; D055815:Young Adult