2950 Gastrostomy Tube Placement in Patients With Ascites: A National Inpatient Sample Analysis

Abstract

INTRODUCTION: As the treatment of liver diseases progress, patients with cirrhosis are living longer, and physicians are facing an increasing need for gastric feeding tube placement to provide enteral nutritional support to these patients. Cirrhotic patients are usually considered as a poor surgical risk candidates, making a surgically placed gastrostomy tube an undesirable option; thus, percutaneous endoscopic gastrostomy (PEG) is often considered to an alternate route to provide enteral nutrition. Cirrhotic patients with portal hypertension often have varices or ascites and are inherently more prone to procedural complications. There is limited data on the safety of the gastrostomy tube in patients with ascites. The aim of our study is to assess the outcomes of gastrostomy tube placement in patients with ascites. METHODS: We conducted a retrospective review of patients with ascites who underwent gastrostomy tube placement using the largest all-payer database, national inpatient sample (NIS) from 2007-2014 using validated ICD-9 codes. Primary and secondary outcomes included in-patient mortality, length of stay (LOS) and total hospital charges, respectively. We adjusted for confounding factors including age, gender, insurance, zip income, and hospital size and location by using multivariate regression. RESULTS: Out of total 2,603,539 hospitalizations for adult patients with ascites, 29,001 patients underwent gastrostomy tube on that hospitalization. Mean age of patients with ascites with gastrostomy 64 ± 2 years with male predominance (55% vs. 45%). The patients with ascites who had gastrostomy tube placed were more likely to die in the hospital (adjusted OR 1.84; 95% CI 1.7-1.9, P = 0.00) as compared to ascites patients without gastrostomy tube. Also, we found a significant increase in mean LOS (28.83 days vs 8.34 days) and mean total charges ($277,404.5 vs $71,874.73). CONCLUSION: Our study is the largest evaluation to date of cirrhotic patients who have undergone PEG. This study suggests that patients with ascites who undergo gastrostomy tube placement have increased mortality, length of stay, and hospital charges. The results of this study point towards caution for the use of PEG in patients with ascites.