Percutaneous Endoscopic Gastrostomy After Cardiac Surgery: A Temporary Measure in a High-Risk Cohort

Abstract

A subset of patients who undergo cardiac surgery require percutaneous endoscopic gastrostomy (PEG) tube for enteral access to receive nutritional support. There are limited data evaluating the outcomes of these patients and the duration of nutritional support required. All cardiac surgery patients (1994 to 2017) were stratified by postoperative PEG requirement. Patients were excluded if they required preoperative nutritional support, began nutritional support more than 30 days postoperatively, or if the PEG was placed more than 90 days after the index cardiac operation. Kaplan-Meier survival analysis was used to estimate overall survival and time to PEG removal. A Fine-Gray competing risk model was constructed to determine factors impacting PEG removal. A total of 16,727 cardiac surgery patients were included, with 310 (1.9%) requiring PEG. The median time to PEG placement was 14.5 (interquartile range, 10 to 22) days with 1 (0.3%) PEG procedural mortality. One-year survival was 50.4% vs 91.8% in the general cardiac surgery population. A total of 113 patients had their PEG removed at a median of 255 days. Of living PEG patients at 1 year, 52.1% had their PEG removed. Factors that were associated with PEG removal were age (hazard ratio [HR], 0.98; P= .03), ejection fraction (HR, 1.03; P < .01), and renal failure (HR, 0.50; P < .01). Patients who require PEG after cardiac surgery are a high-risk cohort. However, those who survive their acute illness often recover to a point where nutrition can be maintained without a feeding tube. These data provide meaningful information for counseling patients and their families that are considering PEG after cardiac surgery.