title: Comparing open gastrostomy tube to percutaneous endoscopic gastrostomy tube in heart transplant patients.
abstract: BACKGROUND
  Impaired wound healing due to immunosuppression has led some surgeons to preferentially use open gastrostomy tube (OGT) over percutaneous gastrostomy tube (PEG) in heart transplant patients when long-term enteral access is deemed necessary.
  
  
  METHODS
  The National Inpatient Sample (NIS) database (2005-2010) was queried for all heart transplant patients. Those receiving OGT were compared to those treated with PEG tube.
  
  
  RESULTS
  There were 498 patients requiring long-term enteral access treated with a gastrostomy tube, with 424 (85.2%) receiving a PEG and 74 (14.8%) an OGT. The PEG cohort had higher Charlson comorbidity Index (4.1 vs. 2.0, p = 0.002) and a higher incidence of post-operative acute renal failure (31.5 vs. 12.7%, p = 0.001). Post-operative mortality was not different when comparing the two groups (13.8 vs. 6.1%, p = 0.06). On multivariate analysis, while both PEG (OR: 7.87, 95%C.I: 5.88-10.52, p < 0.001) and OGT (OR 5.87, 95%CI: 2.19-15.75, p < 0.001) were independently associated with mortality, PEG conferred a higher mortality risk.
  
  
  CONCLUSIONS
  This is the largest reported study to date comparing outcomes between PEG and OGT in heart transplant patients. PEG does not confer any advantage over OGT in this patient population with respect to morbidity, mortality, and length of stay.
authors.affiliation: Temple University School of Medicine, Department of Surgery, Philadelphia, PA, USA.
authors.forename: Vishnu
authors.initials: V
authors.lastname: Ambur
authors.affiliation: Temple University School of Medicine, Department of Surgery, Philadelphia, PA, USA.
authors.forename: Sharven
authors.initials: S
authors.lastname: Taghavi
authors.affiliation: Temple University School of Medicine, Department of Surgery, Philadelphia, PA, USA.
authors.forename: Senthil
authors.initials: S
authors.lastname: Jayarajan
authors.affiliation: Temple University School of Medicine, Biostatistics Consulting Center, Philadelphia, PA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Gaughan
authors.affiliation: Temple University School of Medicine, Department of Cardiac Surgery, Philadelphia, PA, USA.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
authors.affiliation: Temple University School of Medicine, Department of Surgery, Philadelphia, PA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dauer
authors.affiliation: Temple University School of Medicine, Department of Surgery, Philadelphia, PA, USA.
authors.forename: Lars Ola
authors.initials: LO
authors.lastname: Sjoholm
authors.affiliation: Temple University School of Medicine, Department of Surgery, Philadelphia, PA, USA.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Pathak
authors.affiliation: Temple University School of Medicine, Department of Surgery, Philadelphia, PA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Santora
authors.affiliation: Temple University School of Medicine, Department of Surgery, Philadelphia, PA, USA.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Goldberg
keywords: Enteral access; Heart transplant; Immunosuppression; PEG