Highlights
- •In-hospital, 30- and 90-day mortality rates of 7.3%, 13.9% and 20.5% were seen in older patients receiving feeding tubes.
- •Factors associated with mortality were dementia (in hospital), dementia and end-stage liver disease (30-day), and CHF (90-day).
Abstract
Background
Nutrition is essential in the treatment of elderly trauma patients (ETP). ETP experience
dysphagia at rates six times higher than the non-trauma elderly population (NTEP)
and are at increased risk for malnutrition. Operative feeding tube (OFT) placement
is often used to aid with the nutritional management of ETP. Elderly patients experience
higher rates of morbidity and mortality when compared to the general population, especially
in the traumatic setting, with some data suggesting in-hospital mortality as high
as 10%. However, the mortality rates and associated comorbidities associated with
OFT in ETP are unknown. The purposes of this study were to establish the mortality
rate in hospital as well as 30- and 90-days following discharge among elderly trauma
patients (ETP) receiving OFT, and to assess factors associated with mortality within
this population.
Methods
A retrospective review of all trauma patients from a single Level I Trauma Center
from 01/2010-09/2020 was conducted. Exclusion criteria were patients under 65 years
of age or those with previously placed OFT. Demographics, comorbidities, injury mechanisms,
injury severity scores (ISS), and OFT data were collected from the institutional trauma
registry. Mortality data were obtained using the Social Security Death Index. Mortality
at discharge, 30 days, and 90 days following discharge were the primary outcomes.
Bivariate analysis was conducted to compare characteristics and comorbidities of patients
alive and dead at the time points of interest.
Results
There were 151 ETP who received OFT. Patients were largely male (67.5%), severely
injured via a blunt mechanism (95%), and had a median age of 76 years. 11 (7.3%) experienced
in-hospital mortality following feeding tube placement, 21 (13.9%) died within 30
days, and 31 (20.5%) within 90 days. Bivariate analysis demonstrated that ETP who
died were more likely to have a history of dementia (p = 0.004), congestive heart
failure (p = 0.014), and end-stage liver disease (p = 0.034). No other patient or
injury factors were associated with mortality after OFT placement.
Conclusion
Mortality rates for ETP with OFT were higher than anticipated, yet favorable compared
to recently reported data. Patients who died were more likely to have dementia, CHF,
or ESLD than those who survived. The few comorbidities associated with mortality suggest
that nearly all ETP who undergo OFT placement are at risk for mortality. Additionally,
the data highlights the importance of early goals of care discussions for ETP and
their loved ones when operative feeding tubes are being considered.
Level of evidence
Level III.
Study type
Prognostic/Therapeutic/Diagnostic Test/Economic/Decision;
Keywords
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References
- Long-term persistance of the pathophysiologic response to severe burn injury.PLoS One. 2011; 6e21245
Evaluation of nutrition deficits in adult and elderly trauma patients - wade - 2015 - journal of parenteral and enteral nutrition - Wiley Online Library. https://aspenjournals-onlinelibrary-wiley-com.proxy.kumc.edu/doi/full/10.1177/0148607114523450.
- Factors affecting mortality in elderly patients hospitalized for nonmalignant reasons.J Aging Res. 2014; 2014e584315
- One-year mortality in geriatric trauma patients: improving upon the geriatric trauma outcomes score utilizing the social security death index.J Trauma and Acute Care Surg. 2019; 87: 1148-1155
- Benefits of immediate jejunostomy feeding after major abdominal trauma—a prospective, randomized study.J Trauma and Acute Care Surg. 1986; 26: 874-881
- Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis.Ann Surg. 1992; 216: 172-183
- Practice management guidelines for nutritional support of the trauma patient.J Trauma and Acute Care Surg. 2004; 57: 660-679
- Age-dependent risk factors for malnutrition in traumatology and orthopedic patients.Nutrition. 2017; 37: 60-67
- Complications of enteral access.Gastrointest Endosc. 2003; 58: 739-751
- Complications and early mortality in percutaneous endoscopic gastrostomy placement in lombardy: a multicenter prospective cohort study.Dig Liver Dis. 2019; 51: 1380-1387
- Differences in mortality between elderly and younger adult trauma patients: geriatric status increases risk of delayed death.J Trauma and Acute Care Surg. 1998; 45: 805-810
- Complications of surgical and percutaneous nonendoscopic gastrostomy: review of 233 patients.Gastroenterology. 1988; 95: 1206-1210
- Percutaneous endoscopic gastrostomy: the preferred method of elective feeding tube placement in trauma patients.J Trauma and Acute Care Surg. 2002; 52: 26-32
- In-hospital and long-term outcomes after percutaneous endoscopic gastrostomy in patients with malignancy.J Am Coll Surg. 2012; 215: 777-786
- Complications after percutaneous endoscopic gastrostomy in a prospective study.Scand J Gastroenterol. 2012; 47: 737-742
- Predictors of outcome after percutaneous endoscopic gastrostomy: a community-based study.Mayo Clin Proc. 1992; 67: 1042-1049
- Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients.Gastroenterology. 1987; 93: 48-52
- Complication and mortality rate after percutaneous endoscopic gastrostomy are low and indication-dependent.Scand J Gastroenterol. 2014; 49: 891-898
- Comparison of percutaneous endoscopie gastrostomy with stamm gastrostomy.Ann Surg. 1988; 207: 598-603
- Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: a prospective, randomized trial.Surg Endosc. 2006; 20: 1248-1251
- Mortality risk factors after percutaneous gastrostomy: who is a good candidate?.Clin Nutr. 2019; 38: 856-861
- Gastrostomy placement and mortality among hospitalized Medicare beneficiaries.JAMA. 1998; 279: 1973-1976
- Defining the mortality rate of elderly trauma patients with operative feeding tubes.Am Surg. 2022; 31348221096572https://doi.org/10.1177/00031348221096572
- Can percutaneous endoscopic gastrostomy be carried out safely in the elderly?.Geriatr Gerontol Int. 2016; 16: 481-485
- Safety of percutaneous endoscopic gastrostomy tubes in centenarian patients.Clin Endosc. 2018; 51: 56-60
- ACG clinical guideline: nutrition therapy in the adult hospitalized patient.Am J Gastroenterol. 2016; 111 (quiz 335): 315-334
- Swallowing dysfunction in elderly trauma patients.J Crit Care. 2017; 42: 324-327
- A five-year experience with severe injuries in elderly patients.Accid Anal Prev. 1995; 27: 167-174
- Survival after percutaneous endoscopic gastrostomy placement in older persons.J Gerontol A Biol Sci Med Sci. 2000; 55: M735-M739
- Survival after percutaneous endoscopic gastrostomy in older adults with neurologic disorders.Nutr Clin Pract. 2016; 31: 799-804
- Percutaneous endoscopic gastrostomy in older patients with and without dementia: survival and ethical considerations.J Gastroenterol Hepatol. 2019; 34: 736-741
- Long-term outcomes of patients receiving percutaneous endoscopic gastrostomy tubes.J Gen Intern Med. 1996; 11: 287-293
- Hospital and long-term outcome after percutaneous endoscopic gastrostomy.Surg Endosc. 2008; 22: 74-80
- High in-hospital mortality after percutaneous endoscopic gastrostomy: results of a Nationwide population-based study.Clin Gastroenterol Hepatol. 2013; 11 (e3): 1437-1444
- The impact of frailty on failure-to-rescue in geriatric trauma patients: a prospective study.J Trauma Acute Care Surg. 2016; 81: 1150-1155
- Major trauma in the elderly: frailty decline and patient experience after injury.Trauma. 2019; 21: 21-26
Article Info
Publication History
Published online: November 15, 2022
Accepted:
November 10,
2022
Received in revised form:
November 3,
2022
Received:
August 29,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
