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Long-term outcome after percutaneous endoscopic gastrostomy in geriatric Mexican patients

Authors

  • Ana Olivia Cortés-Flores,

    1. Research Unit in Clinical Epidemiology, Specialties Hospital of the Western Medical Center, Medical Unit of High Specialty, Mexican Institute of Social Security, Guadalajara, Mexico
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  • Andrea del Socorro Álvarez-Villaseñor,

    1. Health Research Coordination, Mexican Institute of Social Security, Baja California Sur, Mexico
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  • Clotilde Fuentes-Orozco,

    1. Research Unit in Clinical Epidemiology, Specialties Hospital of the Western Medical Center, Medical Unit of High Specialty, Mexican Institute of Social Security, Guadalajara, Mexico
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  • Kenia Militzi Ramírez-Campos,

    1. Research Unit in Clinical Epidemiology, Specialties Hospital of the Western Medical Center, Medical Unit of High Specialty, Mexican Institute of Social Security, Guadalajara, Mexico
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  • Anais del Roció Ramírez-Arce,

    1. Research Unit in Clinical Epidemiology, Specialties Hospital of the Western Medical Center, Medical Unit of High Specialty, Mexican Institute of Social Security, Guadalajara, Mexico
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  • Michel Dassaejv Macías-Amezcua,

    1. Research Unit in Clinical Epidemiology, Specialties Hospital of the Western Medical Center, Medical Unit of High Specialty, Mexican Institute of Social Security, Guadalajara, Mexico
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  • Mariana Chávez-Tostado,

    1. Research Unit in Clinical Epidemiology, Specialties Hospital of the Western Medical Center, Medical Unit of High Specialty, Mexican Institute of Social Security, Guadalajara, Mexico
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  • Joel Sealtiel Hernández-Machuca,

    1. Research Unit in Clinical Epidemiology, Specialties Hospital of the Western Medical Center, Medical Unit of High Specialty, Mexican Institute of Social Security, Guadalajara, Mexico
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  • Alejandro González-Ojeda

    Corresponding author
    1. Research Unit in Clinical Epidemiology, Specialties Hospital of the Western Medical Center, Medical Unit of High Specialty, Mexican Institute of Social Security, Guadalajara, Mexico
    • Correspondence: Dr Alejandro González-Ojeda MD PhD, Research Unit in Clinical Epidemiology, Western Medical Center, Calle José Enrique Rodo #2558, Colonia Prados Providencia, 44670, Guadalajara, Jalisco, México. Email: avygail5@yahoo.com.mx

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  • Author contributions: AO Cortés-Flores, AS Álvarez-Villaseñor, C Fuentes-Orozco, MD Macías-Amezcua, and A González-Ojeda participated in the protocol design, identification and inclusion of the candidates, collection of clinical information, statistical analysis, and were involved in editing and the final critical revision of the manuscript. M Chávez-Tostado, JS Hernández-Machuca, KM Ramirez-Campos and AR Ramírez-Arce participated in the protocol design, patient follow up, collection of clinical information, statistical analysis, and were involved in editing the manuscript.

Abstract

Aim

To evaluate long-term survival and prognostic factors in elderly Mexican patients who have undergone percutaneous endoscopic gastrostomy (PEG).

Methods

The present study was a retrospective cohort analysis of 110 patients aged older than 70 years without head and neck malignancy who underwent PEG between January 2005 and December 2012. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for demographic and clinical variables, and survival was determined by the Kaplan–Meier method.

Results

Medium age and follow up were 82.45 ± 6.6 years and 688.3 ± 394.6 days, respectively. The patients who died in the early postoperative period (n = 6) were older than those who survived. The Karnofsky performance status and lymphocyte count were non-significantly lower in non-survivors. The body mass index and serum albumin level were lower in non-survivors (P = 0.03 and 0.01, respectively) and Charlson's Comorbidity Index (CCI) was higher. A total of 32 (29%) patients died later in the postoperative period with a mean follow up of 436.2 ± 267.4 days. Risk factors for mortality included Karnofsky Performance Status (odds ratio [OR] 9.76, 95% CI: 3.26–29.3), CCI (OR 7.04, 95% CI: 2.31–21.41) and postoperative hypoalbuminemia (OR 3.45, 95% CI: 1.71–6.67). Postgastrostomy pneumonia occurred in 36.8% of the patients who died during follow-up (OR 0.28, 95% CI: 0.6–1.26).

Conclusions

Karnofsky performance status, Charlson's comorbidity index and postoperative hypoalbuminemia, were independent risk factors for mortality. Modifiable factors are related to nutritional support. Early PEG may help prevent malnutrition and infection. Geriatr Gerontol Int 2015; 15: 19–26.

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