Mortality risk factors after percutaneous gastrostomy: Who is a good candidate?

Background: The percutaneous gastrostomy tube (PG) is an effective and safe way for the delivery of enteral nutrition. The aim of this study was to identify predictive factors for mortality after PG placement. Material and methods: An observational and analytical cohort study was conducted. All endoscopic or radiological percutaneous gastrostomy tubes placed between January 2009 and July 2016 were evaluated. Mortality was the dependent variable. Initial clinical and analytical patient features and the development of complications during follow-up were recorded. Cox regression models were used to evaluate the risk of mortality associated to the studied variables. Hazard ratios with the corresponding 95% confidence intervals were retrieved from these models. Results: A total of 289 patients underwent PG placement (57% male). The mean age was 70.1 (SD 13.6) years. The median follow-up period was 8.7 (IQR 18) months. One hundred and seventy-four patients died during the follow-up period. The overall mortality rate was 4.8 per 100 patients-month. The highest mortality rate was during the first month after PG placement (13.2 per 100 patients-month), subsequently decreasing. Multivariate regression analysis showed that age (HR1year = 1.01; p = 0.015), Charlson comorbidity index >= 4 (HR = 1.69; p = 0.011), the presence of degenerative neurological disease (HR = 1.69; p = 0.012) or malignancy (HR = 2.02; p = 0.012) and the development of aspiration pneumonia during the follow-up period (HR = 3.29; p = 0.001) were statistically significant independent predictive risk factors associated with mortality. A model to predict survival probability prior to placing the PG was developed from the variables of the multivariate analysis. Conclusion: Mortality after PG placement is high. Older age, higher comorbidity and the development of aspiration pneumonia are predictive factors for mortality. A more careful selection of candidates for PG placement should be done to improve the patient prognosis after the procedure. (C) 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.