Scientific Papers
Percutaneous endoscopic gastrostomy reduces total hospital costs in head-injured patients

https://doi.org/10.1016/S0002-9610(98)00206-2Get rights and content

Abstract

Background: Gastrostomies provide reliable long-term enteral access in patients with traumatic brain injuries. The impact of technique of gastrostomy on total hospital cost is not known.

Methods: A retrospective analysis of patients who sustained head trauma and required gastrostomies for long-term enteral access between 1 July 1990 and 1 July 1996 was performed.

Results: The patients who received percutaneous endoscopic gastrostomies (PEG) were similar to patients who received Stamm gastrostomies (OPEN) with respect to age, injury severity score, mechanism of injury, associated injuries, complication rates, and deaths. Total hospital costs ($ × 103) were lower for patients who had PEGs placed in the intensive care unit (78.2 ± 37.4) or endoscopy suite (71.9 ± 37.7) compared with PEGs placed in the operating room (122.4 ± 75.7) or OPEN gastrostomies (119.8 ± 65.1).

Conclusions: In head-injured patients, PEGs are a reliable method of obtaining long-term enteral access with a complication rate equivalent to Stamm gastrostomies. If performed in either the intensive care unit or the endoscopy suite, PEGs are associated with significantly reduced total hospital costs.

Section snippets

Methods

Between July 1, 1990, and July 1, 1996, 132 patients were identified from our computerized trauma registry as having suffered head injuries and required a gastrostomy. The hospital chart was then reviewed for demographic data, associated injuries, length of total hospital stay and ICU stay, type and location of gastrostomy, and discharge disposition. The number of separate operative procedures required to treat traumatic injuries or their complications was also recorded. Procedures performed

Results

Between July 1, 1990, and July 1, 1996, 132 patients with TBI underwent placement of a gastrostomy tube. Eighty-eight patients underwent OPEN gastrostomy and 44 patients underwent PEG. Twelve PEG tubes were placed in the OR, 13 were placed in the endoscopy suite, and 19 were placed in the ICU. Table Ilists the demographic data for patients who had OPEN gastrostomies and PEGs. There were no differences between groups with respect to age, initial Glasgow coma score, injury severity score, number

Comments

Patients with severe TBI frequently have a persistent deficit in neurological arousal and neurologic function and often require a prolonged period of convalescence and rehabilitation. Many of these patients are unable to meet their own nutritional needs, and therefore supplemental nutrition is required.5 Although some authors have demonstrated a decrease in lower esophageal sphincter tone in patients with TBI and have recommended that gastric feeding be avoided,6 many authors have demonstrated

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