P098 Risk stratification tool for gastrostomy insertion in Motor Neurone Disease

Abstract

Abstract Introduction An FVC<50% has traditionally been used to quantify the risk of respiratory compromise in patients with motor neurone disease(MND) undergoing gastrostomy insertion. More recently, a Risk Stratifying Tool(RST) has been developed to better identify those patients who might be at higher risk for the procedure. We set out to evaluate whether there were any differences in the outcomes of high-risk MND patients undergoing gastrostomy insertion as determined by the FVC or RST. Methods A retrospective review of MND patients undergoing gastrostomy insertion was performed between June 2018 and June 2023. Data was collected on demographics, RST variables (orthopnoea, elevated serum bicarbonate or pCO2, or use of NIV), complications, and mortality. Results 42 patients were referred for gastrostomy insertion, only 1 procedure was unsuccessful due to anatomical difficulties. 17 patients (n=8 PEG,n=9 RIG) were classified as high-risk based on FVC<50%, while 30 patients (n=17 PEG,n=13 RIG) were classified as high-risk using the RST. No direct procedure-related complications were recorded in either group. Length of stay(3 vs 3.04 days), 30-day morbidity(23.5% vs 30%), 30-day mortality(0% vs 0%), 6-month mortality(23.5% vs 20%), and median survival(271 days vs 309 day) were comparable between the FVC and RST groups respectively. The RST was more sensitive at identifying patient mortality at 6 months (4/6 vs 6/6 patients). Conclusion Gastrostomy insertion was safe in this cohort of high-risk MND patients, independent of the tool used. Similar morbidity, mortality and length of stay were observed between the two groups. RST was more sensitive for identifying 6-month mortality.