PERCUTANEOUS ENDOSCOPIC GASTROSTOMY TUBE PLACEMENT. WHERE DO WE STAND NOW? DESCRIPTIVE ANALYSIS OF NATIONAL INPATIENT SAMPLE 2013

Percutaneous Endoscopic Gastrostomy (PEG) tube placement was first introduced in 1980s. Currently, PEG tube is the preferred route of nutritional support in patients requiring long-term enteral nutrition. Historically, conditions for which patients are referred for elective PEG tube placement include, but not limited to, cerebrovascular accidents, motor neuron disease, demyelinating disease as well as head and neck malignancy. More recent data regarding patients’ characteristics who undergo PEG tube placement as a consequence of their primary discharge diagnoses are lacking. We aim to identify conditions associated with PEG tube placement. Also, we aim to study overall mortality outcome, healthcare utilization and placement after discharge. We utilized the National Inpatient Sample (NIS) database 2013 data to derive our study population. International classification of disease (ICD-9) codes were used to identify patients who underwent PEG tube placement. Univariate analysis was used to distinguish baseline characteristics, discharge diagnoses, discharge disposition, cost of hospitalization as well as overall in-hospital mortality. A total of 39,320 patients underwent PEG tube placement in 2013 among NIS population. Of those, 21,161 (53.8%) were males and 23,912 (63.8%) were Whites. Discharge diagnoses of cerebrovascular accidents, sepsis, aspiration pneumonia and intracranial injury comprised two-fifths of all cases (40.2%), with each representing 14%, 12.4%, 9.7% and 4.1% respectively -Table 1-. The clear majority (84.9 %) of patients who had PEG tube placement were admitted non-electively. Almost two thirds of patients who underwent PEG tube placement were discharged to a different medical facility (58.8% skilled nursing facility/intermediate care facility and 3.2% short term hospital). 30.9% of patients were discharged home and half of them required home health care. The overall inpatient mortality rate was 6.88%. The mean total hospital charges were 212,276 U.S Dollars. Stroke, sepsis and aspiration pneumonia were the leading primary diagnoses in patients receiving inpatient PEG tube placement. A high percentage of patients who underwent PEG tube placement has required further care in another facility or at home. Health care costs indicates the severity of underlying illness. Further studies on whether mortality and costs outcomes improve in those who undergo PEG tube placement as compared to those who do not are needed.Tabled 11 - Primary Diagnosis for Patients Undergoing Percutaneous Endoscopic Gastrostomy (PEG) Tube PlacementPrimary Discharge DiagnosisNumber of PatientsPercentageCerebrovascular Accident5,49014Sepsis4,89212.4Aspiration Pneumonia3,8129.7Intracranial Injury1,6304.1Malignancy of Head and Neck1,2453.2Surgical Complications1,2273.1Gastrointestinal Disorders1,0322.6Metabolic Disorders8642.2Others19,12848.7Total39,320100 Open table in a new tab