Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2024; 30(10): 1358-1367
Published online Mar 14, 2024. doi: 10.3748/wjg.v30.i10.1358
Time trends and outcomes of gastrostomy placement in a Swedish national cohort over two decades
Martin Löfling Skogar, Magnus Sundbom
Martin Löfling Skogar, Magnus Sundbom, Department of Surgical Sciences, Uppsala University, Uppsala 75185, Sweden
Author contributions: Skogar ML interpretated and analyzed the data and drafted the article; Sundbom M contributed to data acquisition and drafting the article; Skogar ML and Sundbom M contributed equally to conception and design of the study, made critical revisions of the manuscript, and approved the final version of the article to be published.
Institutional review board statement: The study was approved by the Swedish Ethical Review Authority.
Informed consent statement: Since this was a retrospective registry-based study, signed informed consent was not applicable.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Martin Löfling Skogar, MD, PhD, Doctor, Researcher, Statistical Worker, Surgeon, Department of Surgical Sciences, Uppsala University, Entrance 70, 1 Floor, Uppsala 75185, Sweden. martin.skogar@uu.se
Received: November 15, 2023
Peer-review started: November 15, 2023
First decision: December 14, 2023
Revised: December 27, 2023
Accepted: January 31, 2024
Article in press: January 31, 2024
Published online: March 14, 2024
Processing time: 120 Days and 1.7 Hours
ARTICLE HIGHLIGHTS
Research background

Placing a gastrostomy in patients requiring long-term nutritional support is standard care. Since the introduction of percutaneous endoscopic gastrostomy (PEG), there has been a continuous shift towards minimally invasive procedures. However, nationwide population-based data on the use of different techniques and overall outcomes is scarce.

Research motivation

As many patients are frail, the balance between risk and benefit is of particular importance. In the present nationwide population-based cohort, we could evaluate indication, choice of gastrostomy technique, complications, mortality, and time trends over two decades. The dissemination of such findings can lead to improved care.

Research objectives

To study the use of gastrostomies in clinical praxis concerning number and type of procedures (PEG, open gastrostomy, and laparoscopic gastrostomy) as well as indication (malignancy, neurological diseases, cerebrovascular lesions, and non-malignant gastrointestinal conditions). To analyze time trends concerning any shift between the three different methods, procedure-related mortality, and short-term mortality (within 30 d). To explore long-term survival up until 10 years after gastrostomy placement.

Research methods

Data on 48682 individuals who had a gastrostomy between 1998-2019 in Sweden were collected from the mandatory National Patient Register. Indication, type of gastrostomy, and complications were based on registered International Statistical Classification of Diseases and Related Health Problems-diagnoses. Date and cause of death were retrieved by cross-matched data from the Death Register. The cohort was divided into three age groups: Children (0-18 years); adults (19-64 years); and elderly (≥ 65 years). The cohort was also divided by type of gastrostomy: PEG; open gastrostomy; and laparoscopic gastrostomy.

Research results

The annual use of gastrostomies in Sweden increased during the study period, from 13.7/100000 to 22.3/100000 individuals. PEG more than doubled, while a 10-fold increase was seen in laparoscopic gastrostomies. Although the procedure-related mortality was low (0.1%), a 10%-overall 30-d mortality was seen. The latter, however, decreased over time. One-year and ten-year survival rates for children, adults, and elderly were 93.7%, 67.5%, and 42.1% and 79.9%, 39.2%, and 6.8%, respectively. The most common causes of death were malignancies, cardiovascular conditions, and respiratory diseases.

Research conclusions

More and more gastrostomies were placed in Sweden. The increase was due to the number of PEG procedures doubling. Although the 30-d mortality rate decreased during the study period, it was still high (10%). The most common causes of death were consistent with the gastrostomy indication, and as expected long-term survival was mainly dependent on patient age.

Research perspectives

The present nationwide population-based results can be used as a reference in future trials and in quality controls at various levels.