Basic geriatric assessment does not predict in-hospital mortality after PEG placementReport as inadecuate




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BMC Geriatrics

, 12:52

First Online: 06 September 2012Received: 05 December 2011Accepted: 31 August 2012

Abstract

BackgroundPercutaneous endoscopic gastrostomy PEG is an established procedure for long-term nutrition. However, studies have underlined the importance of proper patient selection as mortality has been shown to be relatively high in acute illness and certain patient groups, amongst others geriatric patients. Objective of the study was to gather information about geriatric patients receiving PEG and to identify risk factors associated with in-hospital mortality after PEG placement.

MethodsAll patients from the GEMIDAS database undergoing percutaneous endoscopic gastrostomy in acute geriatric wards from 2006 to 2010 were included in a retrospective database analysis. Data on age, gender, main diagnosis leading to hospital admission, death in hospital, care level, and legal incapacitation were extracted from the main database of the Geriatric Minimum Data Set. Self-care capacity was assessed by the Barthel index, and cognitive status was rated with the Mini Mental State Examination or subjectively judged by the clinician. Descriptive statistics and group comparisons were chosen according to data distribution and scale of measurement, logistic regression analysis was performed to examine influence of various factors on hospital mortality.

ResultsA total of 1232 patients 60.4% women with a median age of 82 years range 60 to 99 years were included. The mean Barthel index at admission was 9.5 ± 14.0 points. Assessment of cognitive status was available in about half of the patients n = 664, with 20% being mildly impaired and almost 70% being moderately to severely impaired. Stroke was the most common main diagnosis 55.2%. In-hospital mortality was 12.8%. In a logistic regression analysis, old age odds ratio OR 1.030, 95% confidence interval CI 1.003-1.056, male sex OR 1.741, 95% CI 1.216-2.493, and pneumonia OR 2.641, 95% CI 1.457-4.792 or the diagnosis group ‘miscellaneous disease’ OR 1.864, 95% CI 1.224-2.839 were identified as statistical risk factors for in–hospital death. Cognitive status did not have an influence on mortality OR 0.447, CI 95% 0.248-1.650.

ConclusionIn a nationwide geriatric database, no component of the basic geriatric assessment emerged as a significant risk factor for mortality after PEG placement, emphasizing individual decision-making.

KeywordsPercutaneous endoscopic gastrostomy PEG Mortality Geriatric assessment  Download fulltext PDF



Author: Christine Smoliner - Dorothee Volkert - Anke Wittrich - Cornel C Sieber - Rainer Wirth

Source: https://link.springer.com/



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