Disease-Based Mortality After Percutaneous Endoscopic Gastrostomy: Utility of the Enterprise Data Warehouse

Benjamin K Poulose, MD, MPH, Joan Kaiser, RN, MS, William C Beck, MD, Pearlie Jackson, PhD, William H Nealon, MD, Kenneth W Sharp, MD, Michael D Holzman, MD, MPH

Vanderbilt University Medical Center

Percutaneous Endoscopic Gastrostomy (PEG) remains a mainstay of enteral access. Thirty day mortality for PEG has ranged from 16-43%. This study aims to discern patient groups that demonstrate limited survival after PEG placement. The Enterprise Data Warehouse (EDW) concept allows an efficient means of integrating administrative, clinical, and quality of life data. Based on this concept, we developed the Vanderbilt Procedural Outcomes Database (VPOD) and analyzed these data for evaluation of post-PEG mortality over time.

Methods: Patients were identified using the VPOD from 2008-2010 and followed for one year post-procedure. Patients were categorized according to common clinical groups for PEG placement: stroke or CNS tumor, progressive neuromuscular disorder, head and neck cancer, other malignancy, or trauma. All-cause mortality at 30, 60, 90, 180, and 360 days was determined by linking VPOD information with the Social Security Death Index. Chi-square analysis was used to determine significance across groups.

Results: Nine hundred fifty-three patients underwent PEG placement during the study period.

p<0.05 between all groups at each time point

Mortality over time was greatest for patients with malignancies other than head and neck cancer and least for trauma patients. Patients with neuromuscular disorders had a similar mortality curve as head and neck cancer patients.

Conclusion: PEG mortality was much higher in patients with malignancies other than head and neck cancer compared to previously published rates. PEG should be employed with great caution in these and other high risk patient groups. This study demonstrates the power of an EDW based database to evaluate large numbers of patients with clinically meaningful results.

Session: Podium Presentation

Program Number: S105

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