Predictors and inpatient outcomes of aspiration pneumonia in patients with percutaneous endoscopic gastrostomy tube: An analysis of national inpatient sample - 13/09/24

Doi : 10.1016/j.clinre.2024.102463

Chengu Niu ^a,^⁎ , Jing Zhang ^b, Abdullah Orakzai ^a, L K Teja Boppana ^c, Ahmed Elkhapery ^a, Basil Verghese ^a, Patrick I Okolo ^d
^a Internal medicine residency program, Rochester General Hospital, Rochester, NY 14621, USA
^b Rainier Springs, Vancouver, WA, 98663, USA
^c University of Florida College of Medicine, Jacksonville, FL 32244, USA
^d Division of Gastroenterology, Rochester General Hospital, Rochester, NY 14621, USA

^⁎Corresponding author. Chengu Niu, 1425 Portland Avenue, Rochester, Internal medicine residency program, Rochester General Hospital, Rochester, NY 14621, USA, Phone: (585) 922-4365, Fax: (585) 922-4440Internal medicine residency program, Rochester General Hospital1425 Portland Avenue, RochesterRochesterNY14621USA

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Research highlights

•	Congestive heart failure and cerebrovascular disease is independent risk for aspiration pneumonia.
•	The consequences of aspiration pneumonia were pronounced.
•	Patients with aspiration pneumonia were notably older and less females.
•	Patients diagnosed with aspiration pneumonia have the extended healthcare requirements.

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Abstract

Background

: Percutaneous endoscopic gastrostomy (PEG) tubes are commonly inserted to provide a route for enteral feeding in patients who are unlikely to have adequate oral intake for prolonged periods of time. This study aims to determine the incidence of aspiration pneumonia among PEG tube patients.

Methods

: We conducted a retrospective analysis of NIS database records (October 2015 to December 2020) for patients with PEG. Primary and secondary outcomes were assessed using ICD-10-CM/PCS codes.

Results

: We identified a total of 2,053,560 weighted hospitalizations involving patients with PEG tube. Those with aspiration pneumonia were older (mean age 67.01 vs. 63.85, p<0.01) and were predominantly male. At baseline, the aspiration pneumonia group had higher rates of dementia (AOR 1.22, 95% CI: 1.19-1.24), malnutrition (AOR 1.13, 95% CI: 1.11-1.15), cerebrovascular disease (AOR 1.29, 95% CI 1.25-1.33), cardiac arrhythmias (AOR 1.05, 95% CI 1.03-1.08), congestive heart failure (AOR 1.20, 95% CI 1.17-1.24), COPD (AOR 1.18, 95% CI 1.15-1.20), paralysis (AOR 1.06, 95% CI 1.03-1.09), alcohol abuse (AOR 1.12, 95% CI 1.07-1.17), and psychoses (AOR 1.07, 95% CI 1.02-1.13). Those with aspiration pneumonia exhibited increased mortality (p<0.01, AOR 1.59, 95% CI 1.54-1.65), higher incidence of severe sepsis (AOR 2.03, 95% CI 1.98-2.07) and longer hospital stays, and accrued greater hospital charges (p<0.01). Notably, while GERD is typically considered a risk factor for AP, our findings indicated that GERD was associated with a decreased risk of AP in this patient population.

Conclusion

: Patients with a PEG tube who develop aspiration pneumonia experience increased mortality rates, extended hospitalizations, a higher frequency of septic shock, and augmented healthcare consumption. Notably, old male, congestive heart failure, cerebrovascular disease, dementia, and COPD play a pivotal role in predicting these outcomes.

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KEYWORDS : Percutaneous endoscopic gastrostomy, Aspiration pneumonia, National inpatient sample, Predictors, Outcomes