Predictors for 30-day mortality and complications following radiologically inserted gastrostomies: a single centre, large cohort review

• Published in: Clinical radiology 2020-05, Vol.75 (5), p.375-382
• Main Authors: Delf, J., Jepson, S., Ramachandran, S., Elabassy, M., Morgan, B., Kenningham, R., Mullineux, J.H., Stephenson, J.A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Female; Gastrostomy - mortality; Humans; Male; Middle Aged; Postoperative Complications - mortality; Radiography, Interventional; Retrospective Studies
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2019.12.020

To measure the 30-day mortality and delayed complication rates following radiologically inserted gastrostomy (RIG) placement and determine the predictive risk factors for 30-day mortality and delayed complications to aide pre-procedure informed consent. Retrospective analysis was undertaken of RIG insertions between July 2012 and August 2017 at a single tertiary centre, which included 373 patients (56% male; median age: 65 years, range: 19–92 years). Data were collected from electronic databases on patient demographics, RIG indication, all-cause mortality, complication rates, patient co-morbidities, and biochemical/haematological parameters. Multivariate analysis was performed to identify predictive risk factors for complications and mortality. The RIG procedural success rate was 97.9%. The overall 30-day mortality rate was 7.8%; associated with pre-procedural haemoglobin 11×109/l (p=0.001, OR 4.18), C-reactive protein >10 mg/l (p=0.003, OR 10.10) and international normalised ratio (INR) >1.2 (p=0.03, OR 4.63). Inpatient RIG referrals were associated with 10% 30-day mortality; compared to 1.1% for outpatients (p=0.028, OR 9.51). The incidence of immediate and delayed complications was 2.4% and 42.1%, respectively. Neuromuscular disease was associated with gastrostomy dislodgement (p=0.0001, OR 4.99) and fracture (p=0.0009, OR 13.45), cerebrovascular disease with gastrostomy dislodgement (p=0.009, OR 2.51), cardiovascular disease with sepsis 30-days post-RIG (p=0.02, OR 2.94), and diabetes mellitus with gastrostomy dislodgement (p=0.0001, OR 29.45), fracture (p=0.027, OR 5.63) and stoma site infections (p=0.0003, OR 7.16). RIG 30-day mortality was significantly associated with inpatient procedures compared to outpatient, and a range of biochemical/haematological parameters that suggest infection pre-intervention. It is advised that the markers of infection and catabolism are investigated pre-intervention, which may reduce mortality and complication rates. •Our study demonstrated a high procedural success rate for RIG insertion.•RIG 30-day mortality was associated with inpatient compared to outpatient referral.•RIG dislodgement was associated with underlying neurological disease.•Diabetes mellitus was associated with RIG site infection, and CVD with sepsis.•Reversing infection and catabolism pre-RIG may reduce mortality/complication rates.