Department of Internal Medicine and Geriatrics, St,-Marien-Hospital Borken, Am Boltenhof 7, 46325, Borken, Germany.
BMC Geriatr. 2012 Sep 6;12:52. doi: 10.1186/1471-2318-12-52.
Percutaneous endoscopic gastrostomy (PEG) is an established procedure for long-term nutrition. However, studies have underlined the importance of proper patient selection as mortality has been shown to be relatively high in acute illness and certain patient groups, amongst others geriatric patients. Objective of the study was to gather information about geriatric patients receiving PEG and to identify risk factors associated with in-hospital mortality after PEG placement.
All patients from the GEMIDAS database undergoing percutaneous endoscopic gastrostomy in acute geriatric wards from 2006 to 2010 were included in a retrospective database analysis. Data on age, gender, main diagnosis leading to hospital admission, death in hospital, care level, and legal incapacitation were extracted from the main database of the Geriatric Minimum Data Set. Self-care capacity was assessed by the Barthel index, and cognitive status was rated with the Mini Mental State Examination or subjectively judged by the clinician. Descriptive statistics and group comparisons were chosen according to data distribution and scale of measurement, logistic regression analysis was performed to examine influence of various factors on hospital mortality.
A total of 1232 patients (60.4% women) with a median age of 82 years (range 60 to 99 years) were included. The mean Barthel index at admission was 9.5 ± 14.0 points. Assessment of cognitive status was available in about half of the patients (n = 664), with 20% being mildly impaired and almost 70% being moderately to severely impaired. Stroke was the most common main diagnosis (55.2%). In-hospital mortality was 12.8%. In a logistic regression analysis, old age (odds ratio (OR) 1.030, 95% confidence interval (CI) 1.003-1.056), male sex (OR 1.741, 95% CI 1.216-2.493), and pneumonia (OR 2.641, 95% CI 1.457-4.792) or the diagnosis group 'miscellaneous disease' (OR 1.864, 95% CI 1.224-2.839) were identified as statistical risk factors for in-hospital death. Cognitive status did not have an influence on mortality (OR 0.447, CI 95% 0.248-1.650).
In a nationwide geriatric database, no component of the basic geriatric assessment emerged as a significant risk factor for mortality after PEG placement, emphasizing individual decision-making.
经皮内镜下胃造口术（PEG）是一种长期营养的既定方法。然而，研究强调了正确选择患者的重要性，因为在急性疾病和某些患者群体（包括老年患者）中，死亡率相对较高。本研究的目的是收集接受 PEG 的老年患者的信息，并确定与 PEG 放置后住院死亡率相关的危险因素。
从 2006 年至 2010 年，从急性老年病房的 GEMIDAS 数据库中纳入所有接受经皮内镜下胃造口术的患者，进行回顾性数据库分析。从老年最小数据集的主数据库中提取年龄、性别、导致住院的主要诊断、住院死亡、护理水平和法律无行为能力的数据。自理能力通过巴氏量表评估，认知状态通过简易精神状态检查或临床医生主观判断进行评估。根据数据分布和测量尺度选择描述性统计和组间比较，进行逻辑回归分析，以检查各种因素对住院死亡率的影响。
共纳入 1232 名患者（60.4%为女性），中位年龄为 82 岁（范围 60 至 99 岁）。入院时平均巴氏量表评分为 9.5±14.0 分。约一半的患者（n=664）进行了认知状态评估，其中 20%为轻度受损，近 70%为中度至重度受损。卒中是最常见的主要诊断（55.2%）。住院死亡率为 12.8%。在逻辑回归分析中，高龄（比值比（OR）1.030，95%置信区间（CI）1.003-1.056）、男性（OR 1.741，95%CI 1.216-2.493）和肺炎（OR 2.641，95%CI 1.457-4.792）或诊断组“其他疾病”（OR 1.864，95%CI 1.224-2.839）被确定为住院死亡的统计学危险因素。认知状态对死亡率没有影响（OR 0.447，CI 95% 0.248-1.650）。
在全国性老年数据库中，PEG 后死亡率没有一个基本老年评估的组成部分成为显著的危险因素，这强调了个体化决策。
