S. Taghavi1, V. Ambur1, S. Jayarajan1, J. Gaughan1, Y. Toyoda1, E. Dauer1, L. Sjoholm1, A. Pathak1, T. Santora1, J. Rappold1, A. Goldberg1 1Temple University School Of Medicine,Department Of Surgery,Philadelpha, PA, USA
Introduction: Lung transplant patients require a high degree of immunosuppression, which impairs wound healing when surgical procedures are required. Open gastrostomy tube (OGT) allows for suturing of the stomach to the anterior abdominal wall, which may decrease the risk of intraperitoneal leak as compared to percutaneous gastrostomy tube (PEG). We hypothesized that because of impaired healing, lung transplant patients requiring gastrostomy tubes would have better outcomes with OGT as compared to PEG.
Methods: The National Inpatient Sample (NIS) Database (2005-2010) was queried for all lung transplant patients requiring open gastrostomy or PEG tube. Weighted frequencies and weighted multivariate logistic regression analysis using clinically relevant variables was used to examine mortality.
Results: There were 215 lung transplant patients requiring gastrostomy tube, with 44 OGT and 171 PEG. The two groups were not different with respect to age (52.0 vs. 56.9 years, p=0.40), Charlson Comorbidity Index (3.3 vs. 3.5, p=0.75) and private payer status (38.6 vs. 32.7%, p=0.05). The PEG cohort was more likely to be male (65.9 vs. 45.0%, p=0.01) or white (93.2 vs. 88.3%, p<0.001) and less likely to be Hispanic (0.0 vs. 5.3%, p<0.001). Incidence of acute renal failure was higher in the PEG group (34.1 vs. 11.7%, p=0.003). Post-operative pneumonia, myocardial infarction, surgical site infection, DVT/PE, and urinary tract infection was not different when comparing the two groups. Length of stay (33.0 vs. 27.1 days, p=0.63) and total hospital charges ($203,023 vs. 294.679, p=0.45) were similar. Post-operative mortality was higher in the PEG group (11.4 vs. 0.0%, p=0.02). On multivariate analysis, PEG tube was independently associated with mortality (HR: 1.94, 95%CI: 1.45-2.58, p<0.001). Increasing Charlson Comorbidity Index was associated with mortality. Variables associated with survival included female gender, age, hospital bed size, and white race (see table).
Conclusion: In lung transplant patients, OGT results in better outcomes as compared to PEG. Open gastrostomy should be the preferred method of gastric access in lung transplant patients.
