title: A large prospective audit of morbidity and mortality associated with feeding gastrostomies in the community.
abstract: Morbidity after 30 days and morbidity after 1 year from gastrostomy placement is poorly characterised as patients are discharged into the community. We prospectively recorded morbidity and mortality associated with gastrostomy placement over a five year period.
  
  
  
  Community dietitians regularly reviewed all patients with a gastrostomy after hospital discharge, prospectively recording morbidity and mortality between 2008 and 2012. In addition hospital databases and case notes were examined. Recorded morbidity included insertion site infection, leakage, over granulation, haemorrhage and buried bumper.
  
  
  
  The commonest indication for PEG placement was following an acute cerebral injury. There were no deaths and few complications directly related to gastrostomy insertion in 350 patients. We collected a total of 571 years of gastrostomy data. Mortality within 30 days was predominantly from a respiratory infection. 30 day, 3 and 12 month cumulative mortality (and morbidity) were 8% (2%), 16% (10%) and 35% (15%) respectively. 38% of patients required treatment for an insertion site infection with 70% of these having further infections. Overall there was a site infection every 2.1 years a gastrostomy was in situ. Complications such as buried bumpers (5(1.4%)), persistent fistulas (0) and over granulation (7(2%)) were rare. Few gastrostomies required replacement (11%).
  
  
  
  We have demonstrated reassuringly low rates of gastrostomy-associated morbidity and mortality. There was no direct mortality. The greatest morbidity resulted from gastrostomy-site infection.
authors.affiliation: Dept of Gastroenterology, Derriford Hospital, Plymouth, PL6 8DH, UK. Electronic address: emilyclarke2@nhs.net.
authors.forename: Emily
authors.initials: E
authors.lastname: Clarke
authors.affiliation: Dept of Gastroenterology, Derriford Hospital, Plymouth, PL6 8DH, UK.
authors.forename: Narrie
authors.initials: N
authors.lastname: Pitts
authors.affiliation: Dept of Gastroenterology, St Marks Hospital, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Latchford
authors.affiliation: Dept of Gastroenterology, Derriford Hospital, Plymouth, PL6 8DH, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lewis
mesh_terms: D000368:Aged; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Gastrostomy; PEG; Percutaneous endoscopic gastrostomy; RIG