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THE IMPACT OF NUTRITION SUPPORT TEAMS ON EMERGENCY ADMISSIONS FOR PERCUTANEOUS ENDOSCOPIC GASTROSTOMY COMPLICATIONS IN ENGLAND 2007-2021:A POPULATION BASED STUDY

Nosheen Umar 1,2, Umair Kamran 1,2, Ben Coupland 3, Nigel Trudgill 2

Affiliations

1 University of Birmingham, Birmingham, United Kingdom

2 Sandwell & West Birmingham Hospitals NHS Trust, West Bromwich, United Kingdom

3 University Hospitals Birmingham, Birmingham, United Kingdom

Summary

AI Generated

In a national English cohort of 108,515 patients, 10.8% had an emergency admission for PEG complications within 5 years of insertion, with absence of a hospital nutrition support team increasing complication admission risk by 16-20%.

Of patients undergoing first PEG insertion in England from 2007 to 2021, 10.8% had an emergency admission due to PEG complication and 1.6% had an elective admission, with 84% of emergency admissions lasting longer than 48 hours.
Hospitals without a nutrition support team had 60.7% emergency admissions due to mechanical PEG complications compared with 49.5% in hospitals with a nutrition support team.
Absence of a trust nutrition support team was associated with increased risk of emergency admissions for PEG complications (adjusted hazard ratio 1.20, 95% CI 1.13-1.28) and any PEG-related complication admission (aHR 1.16, 1.09-1.23).
Oesophageal cancer as PEG indication carried the highest risk for emergency admissions with complications (aHR 2.28, 1.99-2.62), followed by PEG insertion during emergency admission (aHR 1.38, 1.32-1.44) and dementia (aHR 1.27, 1.08-1.49).
This population-based study addresses a gap in long-term PEG complication data and may inform resource allocation decisions regarding nutrition support teams in hospitals performing PEG insertions.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Percutaneous endoscopic gastrostomy (PEG) provides long-term enteral nutrition access in patients with a functional gastrointestinal tract and impaired swallowing. Population-based data on hospital admissions with long term PEG complications are lacking. This study examines the impact of nutrition support teams on admissions with PEG related complications and associated factors.

Aims & Methods

Adults undergoing first PEG insertion in England from 2007 to 2021 were identified in Hospital Episode Statistics. Long term complications (>30 days after PEG) were identified using ICD-10 codes and categorised into two groups: mechanical (PEG obstruction, displacement and leakage) and PEG site infection. Data on NHS trust nutrition support teams were available from GIRFT. The proportion of patients with hospital admissions associated with PEG related complications within 5 years of insertion was calculated. Cox proportional hazards models examined factors associated with both emergency and elective admissions with PEG complications.

Results

Of 108,515 patients (57.7% male; age 69(IQR 57-69)),10.8% had an emergency admission (with 84% for >48 hours) and 1.6% an elective admission due to PEG complication. Hospitals without a nutrition support team had 60.7(36.8-84.2)% emergency admissions due to PEG related mechanical complications compared with 49.5(22.5-90.6)% in hospitals with a nutrition support team.
Factors associated with any emergency admissions for PEG complications included: female (adjusted hazard ratio (aHR) 1.04(95% CI 1.01-1.08)); Asian ethnicity (aHR 1.10(1.02-1.19)); PEG insertion during an emergency admission (aHR 1.38(1.32-1.44)); dementia as PEG indication (aHR 1.27(1.08-1.49)); oesophageal cancer as PEG indication (aHR 2.28(1.99-2.62)); no trust nutrition support team (aHR 1.20(1.13-1.28)) and more recent years of PEG insertion (2021 aHR 1.75(1.52-2.00)). Factors associated with any PEG related complication admission included: PEG insertion during emergency admission (aHR 1.27(1.22-1.32)); oesophageal cancer as PEG indication (aHR 2.24(1.97-2.54)); dementia as PEG indication (aHR 1.24(1.06-1.44); other neurological conditions than stroke as PEG indication (1.16(1.10-1.23)); no trust nutritional support team (aHR 1.16(1.09-1.23)); increasing age (>82 years aHR 0.60(0.57-0.64)); the least deprived quintile (aHR 0.83(0.78-0.87)) and increasing comorbidity Charlson score >5 (aHR 0.86(0.82-0.91)).

Conclusion

10.8% of patients had an emergency admission with a complication within 5 years of PEG insertion, with 84% staying in hospital for >48hrs.The lack of a trust nutritional support team increased the risk of emergency admissions with complications.

Disclosure

No conflict of interest to declare

Conference

UEG Week Copenhagen 2023

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

PP 04 Nutrition (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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