Outcomes following percutaneous endoscopic gastrostomy versus fluoroscopic procedures in the Medicare population

Samantha Maasarani; Syed I Khalid; Chantal Creighton; Athena J Manatis-Lornell; Aaron L Wiegmann; Samantha L Terranella; Nicholas J Skertich; Laura DeCesare; Edie Y Chan

doi:10.1016/j.sopen.2020.06.001

Outcomes following percutaneous endoscopic gastrostomy versus fluoroscopic procedures in the Medicare population

Surg Open Sci. 2020 Jul 17:3:2-7. doi: 10.1016/j.sopen.2020.06.001. eCollection 2021 Jan.

Authors

Samantha Maasarani¹, Syed I Khalid², Chantal Creighton¹, Athena J Manatis-Lornell³, Aaron L Wiegmann², Samantha L Terranella², Nicholas J Skertich², Laura DeCesare², Edie Y Chan²

Affiliations

¹ Chicago Medical School, Rosalind Franklin University, Chicago, IL.
² Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL.
³ Rush Medical College, Rush University Medical Center, Chicago, IL.

Abstract

Background: In the United States, few high-quality manuscripts have directly compared the complication profiles of percutaneous endoscopic versus fluoroscopic gastrostomy. Thus, it is our goal to compare these 2 common procedures to better understand their efficacy and complication profiles.

Materials and methods: A retrospective analysis of patient records from Medicare parts A/B from 2007 to 2012 was used to identify percutaneous fluoroscopic gastrostomy and percutaneous endoscopic gastrostomy procedures. Patient demographics were stratified by age, sex, comorbidities, and complications.

Results: A total of 258,641 patients were found to have either percutaneous fluoroscopic gastrostomy (26,477, 10.2%) or percutaneous endoscopic gastrostomy (232,164, 89.8%). Percutaneous fluoroscopic gastrostomy experienced greater rates for all complications queried. Multivariate analysis revealed that the percutaneous fluoroscopic gastrostomy cohort had statistically significant increased odds for short-term complications, such as ileus (odds ratio 1.4, 95% confidence interval 1.22-1.54), mechanical (odds ratio 2.4, 95% confidence interval 2.28-2.58), wound infection (odds ratio 1.4, 95% confidence interval 1.24-1.52), persistent fistula after tube removal (odds ratio 1.9, 95% confidence interval 1.78-2.12), and other complications (odds ratio 2.2, 95% confidence interval 2.03-2.37), and long-term complications, including abdominal wall pain (odds ratio 1.4, 95% confidence interval 1.33-1.44), wound infection (odds ratio 1.1, 95% confidence interval 1.01-1.15), and persistent fistula after tube removal (odds ratio 1.8, 95% confidence interval 1.72-1.87).

Conclusion: Gastrostomy tubes are more frequently being placed via percutaneous endoscopic and fluoroscopic methods. This study suggests that those undergoing fluoroscopic placement have higher odds of developing short- and long-term postoperative complications.