Utilization and outcomes of surgical gastrostomies and jejunostomies in an era of percutaneous endoscopic gastrostomy: a population-based study

Abstract

Objective: To determine the indications for use of surgical gastrostomy (SG) and surgical jejunostomy (SJ) as feeding tubes, the complications, and the trends in the use of SG and SJ after the introduction of percutaneous endoscopic gastrostomy (PEG) at our institution in 1981.

Design: We conducted a retrospective, population-based cohort study of residents of Olmsted County, Minnesota, who received surgically placed feeding tubes between 1976 and 1989.

Material and methods: The medical records of all Olmsted County residents with surgical placement of a feeding tube during the designated study period were reviewed, and underlying conditions, complications, and survival were analyzed.

Results: Of 77 adult patients (mean age, 66 years; 48% women), 54 underwent SG and 23 had SJ. General anesthesia was used in 42 patients (55%). The indications for SG or SJ were stroke in 23 patients, cancer in 19, other central nervous system-related conditions in 16, and other conditions in 19. Among the numerous comorbid conditions, pulmonary disease (N = 44) and cardiac disease (N = 32) were most frequent. The median duration of follow-up was 181 days. Complications occurred in 31 of 54 patients (57%) with SG and in 13 of 23 (57%) with SJ. Of the 117 complications, 15% were considered major. Twenty patients (26%) resumed eating. Survival at 1, 6, and 12 months was 79%, 49% and 36%, respectively. Most deaths were due to the disease for which the feeding tube had been placed. In a Cox proportional hazards regression analysis, only age and hypoxemia were found to be significantly associated with survival. Hypoxemia, type of tube, central nervous system disease as indication for procedure, and previous aspiration were associated with failure to resume eating (P < 0.05). Survival was similar to that for our patients with PEG during the same period. The overall incidence of feeding tube placement increased throughout the study period.

Conclusion: Patients who require enteral feeding tubes have multiple comorbid conditions that have a major influence on the outcome. The overall incidence of feeding tube placement increased after the introduction of PEG. In patients who require long-term enteral nutrition and are unable to have a feeding tube placed percutaneously, surgically placed feeding tubes have outcomes similar to those reported for patients with PEG.