University Hospitals of Leicester NHS Trust, United Kingdom.
University Hospitals of Leicester NHS Trust, United Kingdom; Gastrointestinal Imaging Group, Digestive Disease Centre, University Hospitals of Leicester, United Kingdom.
Clin Radiol. 2020 May;75(5):375-382. doi: 10.1016/j.crad.2019.12.020. Epub 2020 Jan 28.
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 <130 g/l in men (p=0.030, odds ratio [OR] 23.38), white cell count >11×10/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.
测量放射引导下胃造口术（RIG）置管后 30 天死亡率和迟发性并发症发生率，并确定 30 天死亡率和迟发性并发症的预测风险因素，以辅助术前知情同意。
对 2012 年 7 月至 2017 年 8 月在一家三级中心进行的 RIG 插入进行回顾性分析，共纳入 373 例患者（56%为男性；中位年龄：65 岁，范围：19-92 岁）。从电子数据库中收集患者人口统计学、RIG 适应证、全因死亡率、并发症发生率、患者合并症和生化/血液学参数等数据。进行多变量分析以确定并发症和死亡率的预测风险因素。
RIG 手术成功率为 97.9%。总体 30 天死亡率为 7.8%；与术前血红蛋白<130 g/l 的男性相关（p=0.030，优势比[OR]23.38），白细胞计数>11×10/l（p=0.001，OR 4.18），C 反应蛋白>10 mg/l（p=0.003，OR 10.10）和国际标准化比值（INR）>1.2（p=0.03，OR 4.63）。住院患者的 RIG 转介与 10%的 30 天死亡率相关；与门诊患者的 1.1%相比（p=0.028，OR 9.51）。即时和迟发性并发症的发生率分别为 2.4%和 42.1%。神经肌肉疾病与胃造口管移位（p=0.0001，OR 4.99）和骨折（p=0.0009，OR 13.45）相关，脑血管疾病与胃造口管移位（p=0.009，OR 2.51）相关，心血管疾病与 RIG 后 30 天败血症（p=0.02，OR 2.94）相关，糖尿病与胃造口管移位（p=0.0001，OR 29.45）、骨折（p=0.027，OR 5.63）和造口部位感染（p=0.0003，OR 7.16）相关。
与门诊患者相比，RIG 30 天死亡率与住院患者手术显著相关，与一系列提示感染的生化/血液学参数相关。建议在干预前检查感染和分解代谢的标志物，这可能会降低死亡率和并发症发生率。
