Maasarani Samantha, Khalid Syed I, Creighton Chantal, Manatis-Lornell Athena J, Wiegmann Aaron L, Terranella Samantha L, Skertich Nicholas J, DeCesare Laura, Chan Edie Y
Chicago Medical School, Rosalind Franklin University, Chicago, IL.
Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL.
Surg Open Sci. 2020 Jul 17;3:2-7. doi: 10.1016/j.sopen.2020.06.001. eCollection 2021 Jan.
In the United States, few high-quality manuscripts have directly compared the complication profiles of percutaneous endoscopic versus fluoroscopic gastrostomy. Thus, it is our goal to compare these 2 common procedures to better understand their efficacy and complication profiles.
A retrospective analysis of patient records from Medicare parts A/B from 2007 to 2012 was used to identify percutaneous fluoroscopic gastrostomy and percutaneous endoscopic gastrostomy procedures. Patient demographics were stratified by age, sex, comorbidities, and complications.
A total of 258,641 patients were found to have either percutaneous fluoroscopic gastrostomy (26,477, 10.2%) or percutaneous endoscopic gastrostomy (232,164, 89.8%). Percutaneous fluoroscopic gastrostomy experienced greater rates for all complications queried. Multivariate analysis revealed that the percutaneous fluoroscopic gastrostomy cohort had statistically significant increased odds for short-term complications, such as ileus (odds ratio 1.4, 95% confidence interval 1.22-1.54), mechanical (odds ratio 2.4, 95% confidence interval 2.28-2.58), wound infection (odds ratio 1.4, 95% confidence interval 1.24-1.52), persistent fistula after tube removal (odds ratio 1.9, 95% confidence interval 1.78-2.12), and other complications (odds ratio 2.2, 95% confidence interval 2.03-2.37), and long-term complications, including abdominal wall pain (odds ratio 1.4, 95% confidence interval 1.33-1.44), wound infection (odds ratio 1.1, 95% confidence interval 1.01-1.15), and persistent fistula after tube removal (odds ratio 1.8, 95% confidence interval 1.72-1.87).
Gastrostomy tubes are more frequently being placed via percutaneous endoscopic and fluoroscopic methods. This study suggests that those undergoing fluoroscopic placement have higher odds of developing short- and long-term postoperative complications.
在美国，很少有高质量的手稿直接比较经皮内镜胃造口术与透视引导下胃造口术的并发症情况。因此，我们的目标是比较这两种常见手术，以更好地了解它们的疗效和并发症情况。
对2007年至2012年医疗保险A/B部分的患者记录进行回顾性分析，以确定透视引导下经皮胃造口术和经皮内镜胃造口术。患者人口统计学特征按年龄、性别、合并症和并发症进行分层。
共发现258,641例患者接受了透视引导下经皮胃造口术（26,477例，10.2%）或经皮内镜胃造口术（232,164例，89.8%）。透视引导下经皮胃造口术在所有查询的并发症发生率上更高。多变量分析显示，透视引导下经皮胃造口术队列发生短期并发症的几率在统计学上显著增加，如肠梗阻（优势比1.4，95%置信区间1.22 - 1.54）、机械性并发症（优势比2.4，95%置信区间2.28 - 2.58）、伤口感染（优势比1.4，95%置信区间1.24 - 1.52）、拔管后持续性瘘管（优势比1.9，95%置信区间1.78 - 2.12）以及其他并发症（优势比2.2，95%置信区间2.03 - 2.37），还有长期并发症，包括腹壁疼痛（优势比1.4，95%置信区间1.33 - 1.44）、伤口感染（优势比1.1，95%置信区间1.01 - 1.15）和拔管后持续性瘘管（优势比1.8，95%置信区间1.72 - 1.87）。
胃造口管更多地通过经皮内镜和透视引导方法放置。本研究表明，接受透视引导放置的患者发生术后短期和长期并发症的几率更高。
