Mohammed, F.; Gasem, J.; Balakrishnan, S.; Hurst, S.; Conlong, P.; Rameh, B.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA97
Academic Journal
Background: A previous audit at the Royal Oldham Hospital done between March 1999 and June 2000 had shown that there was a 42% mortality at 30 days after PEG tube insertion in hospitalised patients. Several recommendations were made after this audit: patient's head to be kept at an angle of 30-45 degrees when feeding; recheck gastric contents before feeds (if greater than 150 mis residue aspirated then withhold feeds); and use of a gastroenterology specialist nurse to assess patients before and after PEG tube insertion. Our aim was to determine whether these measures led to a reduction in 30 day mortality in hospitalised patients. Methods: Reviewed the medical records of hospitalised patients who underwent PEG insertion between June 2000 and December 2001. Cause of death was identified from clinical notes and death certificates for patients who died within 30 days of PEG insertion. Results: 73 PEG tubes were inserted during the audit period. 73% of patients were more than 70 years of age (range 38-98). 51 patients (70%) had PEG tubes because of dysphagia secondary to a cerebrovascular accident. 58 patients (80%) had their PEG tubes inserted within one week of referral and 5 patients had insertion delayed because of the need for further assessment prior to PEG insertion. There were no immediate deaths during or within 24 hours of the procedure but there were 16 deaths (22%) within 30 days and 9 (12%) of these were PEG related. There was a statistically significant difference (p < 0.05) in mortality compared to the previous audit period. Conclusions: Careful assessment of patients before and after PEG tube insertion and implementation of specific feeding guidelines can decrease the 30 day mortality after PEG tube insertion.


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