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TRENDS AND OUTCOMES OF OPERATIVELY PLACED FEEDING TUBES
John Afthinos*1, Roman Grinberg2, Karen E. Gibbs2
1Surgery, Long Island Jewish Forest Hills, Forest Hlls, NY; 2Surgery, Staten Island University Hospital, Staten Island, NY
Introduction: Operatively placed feeding tubes (FT) are integral in managing select post-operative patients allowing for enteral feeding during the catabolic state of recovery. We wished to evaluate the outcomes related to their utilization by employing a large national database.
Methods: The NIS database was queried for operatively placed gastrostomy tube (GT) and jejunostomy tubes (JT) during the years 2005 - 2011. Patients were evaluated for age, gender, comorbid conditions and post-operative complications. Length of stay (LOS) and mortality rates were calculated. Multivariate logistic regression analysis was performed to identify potential risk factors for post-operative mortality. In addition, annual utilization of a laparoscopic approach was also tabulated.
Results: A total of 421,223 operatively placed feeding tubes were identified, of which 169,068 (41%) were JT. GT patients were slightly older that JT patients (49 + 30 vs. 48 + 30 years, p < 0.0001). A higher proportion of JT patients were men (58%). LOS was longer for GT patients (23 + 30 vs. 20 + 30 days, p < 0.0001). Morbidity was significantly lower for GT vs. JT (18% vs. 25%, p < 0.001) as was mortality (8% vs. 10%, p < 0.0001). Risk factors predicting mortality for operatively placed FT include PE (OR 2.1, p < 0.001) post-operative shock (OR 3.7, P < 0.001), the use of JT (OR 1.3, p < 0.001) and placement during laparotomy (OR 1.4, p < 0.001). Annual laparoscopic utilization was low (Table 1).
Conclusion: JT have a higher overall morbidity and mortality compared to GT. The mortality is similar for published mortality for endoscopically placed gastrostomy tubes (10%). Laparoscopic utilization remains low and the reasons for this are unclear.
Table 1.
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