V. Ambur1, S. Taghavi1, S. Jayarajan1, J. Gaughan1, Y. Toyoda1, E. Dauer1, L. Sjoholm1, A. Pathak1, T. Santora1, J. Rappold1, A. Goldberg1 1Temple University,Department Of Surgery,Philadelpha, PA, USA
Introduction:
Impaired wound healing due to immunosuppression has led some surgeons to preferentially use open gastrostomy tube (OGT) over percutaneous gastrostomy tube (PEG) in heart transplant patients. OGT allows for pexying of the stomach to the anterior abdominal wall, which may decrease the risk of intra-abdominal leak compared to PEG, potentially resulting in better outcomes. We hypothesized that heart transplant patients requiring gastric access would have better outcomes with OGT compared to PEG.
Methods:
The National Inpatient Sample (NIS) database (2005-2010) was queried for all heart transplant patients requiring open gastrostomy or PEG tube. Weighted frequencies and weighted multivariate logistic regression analysis using clinically relevant variables were used to examine clinical characteristics and mortality.
Results:
There were 498 patients requiring gastrostomy tube, with 424 (85.2%) requiring PEG and 74 (14.8%) requiring OGT. The two groups were not different with respect to male gender (76% vs. 78%, p=0.68). The PEG cohort was older (53.5 vs. 28.5, p=<0.001), more likely Caucasian (73.5% vs. 53.3%, p<0.001), less likely to be Hispanic (3.1 vs. 18.3%, p<0.001), and had higher Charlson comorbidity Index (4.1 vs. 2.0, p=0.002). The PEG cohort had a higher incidence of post-operative acute renal failure (31.5 vs. 12.7%, p=0.001) and a higher incidence of having any postoperative complication (42.3% vs 19.1%, p<0.001). Rate of post-operative pneumonia (3.4% vs 0%, p=0.1), surgical site infection (4.8% vs 6.4%, p=0.56), deep vein thrombosis (3.5% vs. 0%, p=0.1), and pulmonary embolism (2.6% vs 0%, p=0.16) were not significantly different when comparing the two groups. Median length of stay (20.0 vs 14.0 days, p <0.005) was longer in the PEG cohort, however total hospital charges were not different ($224,795 vs. $183,474, p=0.41). Post-operative mortality was not different when comparing the two groups (13.8 vs. 6.1%, p=0.06). On multivariate analysis, while both PEG (HR: 7.87, 95%C.I: 5.88-10.52, p<0.001) and OGT (HR 5.87, 95%CI: 2.19-15.75, p<0.001) were independently associated with mortality, PEG had higher mortality risk. Other variables associated with increased mortality included increasing age and increasing Charlson comorbidity Index. Caucasian race and admission to a teaching hospital were associated with lower mortality (Table 1).
Conclusion:
In heart transplant patients, PEG appears to result in worse morbidity and mortality compared to OGT. OGT should be the preferred method of gastric access in heart transplant patients.
