P. M. Alvarez1, J. Herb2, A. Vijay1, C. Cunningham1, K. Anderson1, S. Francois1, K. Herbert1, N. Bartl1, E. Hoke2, J. Jadi1, N. Rodriguez-Ormaza2,3, R. Maine2, E. Dreesen2, A. Charles2, T. Reid2 1University Of North Carolina At Chapel Hill,School Of Medicine,Chapel Hill, NC, USA 2University Of North Carolina At Chapel Hill,Department Of General Surgery,Chapel Hill, NC, USA 3University Of North Carolina At Chapel Hill,Department Of Epidemiology,Chapel Hill, NC, USA
Introduction: While surgical and non-surgical services routinely place gastrostomy tubes, few investigations have examined the procedure’s outcomes based on performing service. This study describes baseline characteristics, complications, and mortality among patients who had gastrostomy tubes placed by either a surgical or non-surgical service.
Methods: This is a retrospective study of all adult patients who underwent gastrostomy tube placement at UNC from March 2014 to July 2017. Baseline characteristics included age, sex, BMI, substance abuse, comorbidities, previous abdominal surgery, and prior gastrostomy tube. We compared placement by surgical versus non-surgical services outcomes, including severe and minor complications, and mortality, overall and gastrostomy tube related.
Results: Of the 1,339 adults who underwent gastrostomy tube placement, 45%(n=626) were placed by surgical services and 55% (n=713) were placed by non-surgical services. Baseline characteristics were similar although non-surgical services had higher rates of congestive heart failure (p=0.004) and COPD (p=0.05). Non-surgical services placed all gastrostomy tubes percutaneously, while surgical services placed 52.6% percutaneously, 37.3% laparoscopically, and 10.1% open. Mortality related to gastrostomy tube placement was similar (surgical 0.6% vs nonsurgical 0.5%, p=1.0), however overall mortality was higher among non-surgical services (23.7% vs 16.5%, p=0.004). There was no difference in major or minor complication rate (27.3% surgical vs 27.2% non-surgical, p=0.88).
Conclusion: Surgical and non-surgical service placement of gastrostomy tubes had equivalent gastrostomy tube related mortality and complication rates, although patients with gastrostomy tubes placed by non-surgical services experienced higher overall hospital mortality. The high in-hospital mortality and complication rates underscore the need for thoughtful patient selection for this procedure.