Long-term outcome after percutaneous endoscopic gastrostomy in geriatric Mexican patients

Abstract

Aim: To evaluate long-term survival and prognostic factors in elderly Mexican patients who have undergone percutaneous endoscopic gastrostomy (PEG).

Methods: The present study was a retrospective cohort analysis of 110 patients aged older than 70 years without head and neck malignancy who underwent PEG between January 2005 and December 2012. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for demographic and clinical variables, and survival was determined by the Kaplan-Meier method.

Results: Medium age and follow up were 82.45 ± 6.6 years and 688.3 ± 394.6 days, respectively. The patients who died in the early postoperative period (n = 6) were older than those who survived. The Karnofsky performance status and lymphocyte count were non-significantly lower in non-survivors. The body mass index and serum albumin level were lower in non-survivors (P = 0.03 and 0.01, respectively) and Charlson's Comorbidity Index (CCI) was higher. A total of 32 (29%) patients died later in the postoperative period with a mean follow up of 436.2 ± 267.4 days. Risk factors for mortality included Karnofsky Performance Status (odds ratio [OR] 9.76, 95% CI: 3.26-29.3), CCI (OR 7.04, 95% CI: 2.31-21.41) and postoperative hypoalbuminemia (OR 3.45, 95% CI: 1.71-6.67). Postgastrostomy pneumonia occurred in 36.8% of the patients who died during follow-up (OR 0.28, 95% CI: 0.6-1.26).

Conclusions: Karnofsky performance status, Charlson's comorbidity index and postoperative hypoalbuminemia, were independent risk factors for mortality. Modifiable factors are related to nutritional support. Early PEG may help prevent malnutrition and infection.

Keywords: gastrostomy; hypoalbuminemia; morbidity; mortality; pneumonia.