Predicting which patients can resume oral nutrition after percutaneous endoscopic gastrostomy tube placement

Authors

  • A. D. Naik,

    1. Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
    2. Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, Yale, CT, USA
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  • N. S. Abraham,

    1. Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
    2. Gastroenterology Section, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
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  • V. M. L. Roche,

    1. Mildred and Ivor Wold Center for Geriatrics, University of Texas Southwestern Medical School, Dallas, TX, USA
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  • J. Concato

    1. Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, Yale, CT, USA
    2. Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT, USA
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Dr A. D. Naik, Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center (152), 2002 Holcombe Blvd, Houston, TX 77030, USA.
E-mail: anaik@bcm.tmc.edu

Summary

Background : Percutaneous endoscopic gastrostomy tubes are placed with high frequency and relative safety for a variety of indications. One of these indications is temporary nutritional support for patients expected to resume oral nutrition.

Aims : To determine if baseline clinical characteristics can predict which patients attain the clinical goal of resuming oral nutrition with consequent tube removal.

Methods : We conducted a single site observational cohort study from December 1999 to April 2001, enrolling all patients scheduled for percutaneous endoscopic gastrostomy placement. Standard descriptive and bivariate analyses were performed. Cox proportional hazard models were constructed to identify patient characteristics prior to percutaneous endoscopic gastrostomy placement that might predict resumption of oral nutrition with tube removal.

Results : Bivariate analyses revealed four potential clinical predictors: age <65 years, localized head and neck cancer, serum albumin ≥3.75 g/dL, and serum creatinine ≤1.1 mg/dL. In multivariable analysis, age < 65 years (HR = 3.7, 95% CI: 1.0–14.3) and a diagnosis of localized head and neck cancer (HR = 4.6, 95% CI: 1.4–15.0) predicted resumption of oral nutrition with percutaneous endoscopic gastrostomy removal.

Conclusions : When discussing percutaneous endoscopic gastrostomy placement, doctors should consider the likelihood of achieving clinically important outcomes such as the resumption of oral nutrition with tube removal. This clinical goal is unlikely for older patients with diagnoses other than localized head and neck cancer.

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