PMO-044 Mortality post percutaneous endoscopic gastrostomy insertion: a root-cause analysis

Introduction Meta-analysis has demonstrated a 19% 30-day mortality following Percutaneous Endoscopic Gastrostomy (PEG) insertion. 1 The 2008 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) 2 retrospectively audited inpatient death, demonstrating poor patient selection and use of multidisciplinary assessment. The figures demonstrated the need for endoscopy units to engage in regular audit of PEG insertion and suggested reviewing all cases of mortality within 30 days of procedure. Methods A root-cause analysis of mortality after inpatient PEG insertion was undertaken from over 1 year from June 2010 to May 2011 at West Middlesex University Hospital, London. Results 45 patients underwent PEG insertion with an average age of 72.66 years (range 33–100; 19 females; 26 males). Indications were neurological in 96% (43). Six were for PEG re-insertion following tube failure. Most were American Society of Anaesthesiologists (ASA) grade II (56%). The one ASA IV case was an intensive care unit inpatient. The 30-day mortality was 20%, with an average age of 82.9 years and average survival of 14.4 days. All indications for insertion were for poor swallow post stroke. The majority of patients were ASA-II. All causes of death were all attributed to pneumonia on their death certificates. None of the deaths were procedure related. However, these patients demonstrated multiple co-morbidities and a poor functional baseline level pre-procedure. 20 patients died within 365 days (44.4% 1 year mortality) with an average age at insertion of 81.8 years. Conclusion The 30-day mortality rate in this study mirrors that found in previous published data, with all known deaths due to respiratory disease; none were found to be procedure related deaths. This is despite careful patient selection, assessment by a multidisciplinary team and the application of other recommendations of the NCEPOD report. It would be prudent for further review and audit of careful selection of appropriateness for PEG particularly in cases with multiple comorbidities with consideration into the futility of the procedure. Thus patient selection for PEG insertion remains a difficult problem. Competing interests None declared. References 1. Mitchell SL, Tetroe JM. Survival after percutaneous endoscopic gastrostomy placement in older persons. J Gerontol A Biol Sci Med Sci 2000; 55 :M735–9. 2. Johnston S, Tham T, Mason M. Death after PEG: results of the national confidential enquiry into patient outcome and death. Gastrointestinal Endoscopy 2008; 68 :223–7.