Time trends and outcomes of gastrostomy placement in a Swedish national cohort over two decades

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.