Long-term follow-up of consequences of percutaneous endoscopic gastrostomy (PEG) tubes in nursing home patients

• Published in: Digestive diseases and sciences Vol. 39; no. 4; pp. 738 - 743
• Main Authors: MADHUKAR KAW, SEKAS, G
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Heidelberg Springer 01-04-1994
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cerebrovascular Disorders - therapy; Dementia - therapy; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Enteral Nutrition; Follow-Up Studies; Humans; Incidence; Intensive care medicine; Intubation, Gastrointestinal - adverse effects; Intubation, Gastrointestinal - mortality; Medical sciences; Nursing Homes; Nutritional Status; Resuscitation Orders; Retrospective Studies; Serum Albumin - analysis; Survival Analysis; Time Factors; Treatment Outcome; Gastrostomy; Human; Prognosis; Complication; Endoscopy; Long term; Survival; Resuscitation; Nutritional status; Parenteral administration; Feeding; Percutaneous route
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/bf02087416

PEG (percutaneous endoscopic gastrostomy) tubes are frequently placed in nursing home patients. The aim of this study was to assess retrospectively the long-term changes in functional and nutritional statuses, tube-related complications, and factors influencing survival in 46 nursing home residents, mean age 73.6 years (range 19-96). Functional status was evaluated by a standard rehabilitation medicine scale. Nutritional status was evaluated by serum albumin and cholesterol concentrations and by weight. PEG-related complications requiring hospitalization or emergency room or clinic evaluations were noted. Additionally, changes in resuscitation status were noted. The predominant indication for PEG placement was dementia (52%). At PEG placement, 48% of patients had total functional impairment. Regardless of the severity of impairment, no patient's functional status improved after PEG. Nutritional status did not improve significantly. Mortality approached 50% and 60% at 12 and 18 months, respectively, and was significantly related to age, resuscitation status, and serum albumin concentration. All patients under 40 years of age at PEG survived, in contrast to 41.3% of patients over 40 years of age (P < 0.001). Sixty-three percent of patients who were "full code" at PEG placement survived, in contrast to 10% of "no code" patients (P < 0.001). Albumin > or = 3.5 g/dl at PEG or thereafter was associated with improved survival (P < 0.001) as compared to albumin < 3.5 g/dl. PEG-related complications occurred in 34.7% of patients, and the first occurred four months after PEG. We conclude that realistic expectations of what PEG can accomplish be a factor in the decision to place a PEG tube in nursing home patients.