Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2024; 30(10): 1358-1367
Published online Mar 14, 2024. doi: 10.3748/wjg.v30.i10.1358
Time trends and outcomes of gastrostomy placement in a Swedish national cohort over two decades
Martin Löfling Skogar, Magnus Sundbom
Martin Löfling Skogar, Magnus Sundbom, Department of Surgical Sciences, Uppsala University, Uppsala 75185, Sweden
Author contributions: Skogar ML interpretated and analyzed the data and drafted the article; Sundbom M contributed to data acquisition and drafting the article; Skogar ML and Sundbom M contributed equally to conception and design of the study, made critical revisions of the manuscript, and approved the final version of the article to be published.
Institutional review board statement: The study was approved by the Swedish Ethical Review Authority.
Informed consent statement: Since this was a retrospective registry-based study, signed informed consent was not applicable.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Martin Löfling Skogar, MD, PhD, Doctor, Researcher, Statistical Worker, Surgeon, Department of Surgical Sciences, Uppsala University, Entrance 70, 1 Floor, Uppsala 75185, Sweden. martin.skogar@uu.se
Received: November 15, 2023
Peer-review started: November 15, 2023
First decision: December 14, 2023
Revised: December 27, 2023
Accepted: January 31, 2024
Article in press: January 31, 2024
Published online: March 14, 2024
Processing time: 120 Days and 1.7 Hours
Abstract
BACKGROUND

Percutaneous endoscopic gastrostomy (PEG) and laparoscopically inserted gastrostomy have become the gold standard for adult patients and children, respectively, requiring long-term enteral nutrition support. Procedure-related mortality is a rare event, often reported to be zero in smaller studies. National data on 30-d mortality and long-term survival rates after gastrostomy placement are scarce in the literature.

AIM

To study the use of gastrostomies in Sweden from 1998-2019 and to analyze procedure-related mortality and short-term (< 30 d) and long-term survival.

METHODS

In this retrospective, population-based cohort study, individuals that had received a gastrostomy between 1998-2019 in Sweden were included. Individuals were identified in the Swedish National Patient Register, and survival analysis was possible by cross-referencing the Swedish Death Register. The cohort was divided into three age groups: Children (0-18 years); adults (19-64 years); and elderly (≥ 65 years). Kaplan-Meier with log-rank test and Cox regression were used for survival analysis.

RESULTS

In total 48682 individuals (52% males, average age 60.9 ± 25.3 years) were identified. The cohort consisted of 12.0% children, 29.5% adults, and 58.5% elderly. An increased use of gastrostomies was observed during the study period, from 13.7/100000 to 22.3/100000 individuals (P < 0.001). The use of PEG more than doubled (about 800 to 1800/year), with a corresponding decrease in open gastrostomy (about 700 to 340/year). Laparoscopic gastrostomy increased more than ten-fold (about 20 to 240/year). Overall, PEG, open gastrostomy, and laparoscopic gastrostomy constituted 70.0% (n = 34060), 23.3% (n = 11336), and 4.9% (n = 2404), respectively. Procedure-related mortality was 0.1% (n = 44) overall (PEG: 0.05%, open: 0.24%, laparoscopic: 0.04%). The overall 30-d mortality rate was 10.0% (PEG: 9.8%, open: 12.4%, laparoscopic: 1.7%) and decreased from 11.6% in 1998-2009 vs 8.5% in 2010-2019 (P < 0.001). One-year and ten-year survival rates for children, adults, and elderly were 93.7%, 67.5%, and 42.1% and 79.9%, 39.2%, and 6.8%, respectively. The most common causes of death were malignancies and cardiovascular and respiratory diseases.

CONCLUSION

The annual use of gastrostomies in Sweden increased during the study period, with a shift towards more minimally invasive procedures. Although procedure-related death was rare, the overall 30-d mortality rate was high (10%). To overcome this, we believe that patient selection should be improved.

Keywords: Gastrostomy; Percutaneous endoscopic gastrostomy; Dysphagia; Enteral nutrition; Long-term; Survival; Complication

Core Tip: In this large population-based cohort of 48682 individuals, the use of gastrostomies in Sweden increased during the 22-year study period, from 13.7/100000 to 22.3/100000 individuals. Percutaneous endoscopic gastrostomy more than doubled, while a 10-fold increase was seen in laparoscopic gastrostomies. Although the procedure-related mortality was low (0.1%), a 10% 30-d mortality was seen. The latter, however, decreased from 11.6% in 1998-2009 to 8.5% in 2010-2019. One-year and ten-year survival rates for children, adults, and elderly were 93.7%, 67.5%, and 42.1% and 79.9%, 39.2%, and 6.8%, respectively. The most common causes of death were malignancies and cardiovascular and respiratory diseases.