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PERCUTANEOUS GASTROSTOMY PLACEMENT IN PATIENTS WITH COVID-19 INFECTION: CLINICAL OUTCOMES AND THE INFREQUENT NEED FOR LONG-TERM ENTERAL ACCESS
Gastroenterology ; 162(7):S-276-S-277, 2022.
Article in English | EMBASE | ID: covidwho-1967261
ABSTRACT

Introduction:

The global pandemic caused by SARS-CoV-2 (COVID-19) has caused respiratory failure and prolonged intubation in millions of patients. As rates of new hospitalizations in America for COVID-19 decline, clinicians must now address maintenance management of a prolonged illness. Gastrostomy tubes provide a method for enteral feeding over a prolonged period of critical illness and recovery. Understanding outcomes in COVID-19 infected patients after gastrostomy tube placement and rates of long-term enteral feeding requirements is necessary in order to ensure proper allocation of a limited resource and guide patient decision making, and has not been previously studied. We sought to identify clinical factors associated with in-hospital mortality after gastrostomy tube placement and describe rates of long-term gastrostomy tube requirements.

Methods:

All adult patients undergoing gastrostomy tube placement admitted with COVID-19 between 1/1/2020-5/1/ 2021 at two of Northwell Health tertiary referral centers in New York were identified. We analyzed medical history, hospital course, procedural details, respiratory status at time of gastrostomy, long-term gastrostomy needs as well as risk factors for mortality.

Results:

A total of 155 patients underwent gastrostomy tube placement during the study period. The mean age was 64 years old, 61% were male, and mean duration of time from intubation to gastrostomy tube placement was 35 days. 73% of patients were ventilator dependent at time of gastrostomy tube placement. (Table 1) Overall, 27% (n=42) of patients expired during index admission after gastrostomy tube placement. In-hospital mortality was associated with ventilator dependence at time of gastrostomy placement (OR 4.8133, 95% CI, p=0.005). In-hospital mortality was not associated with age, elderly status, obesity, medications, or duration of intubation. (Table 2) Among the 113 patients discharged from index admission, post-discharge follow-up was available for 111 patients, with average follow-up time of 127 days. Among patients with follow-up, 61% (n=68) no longer required gastrostomy tube at follow-up visits.

Discussion:

Gastrostomy tube placement is often performed in patients with prolonged critical illness. With limited clinical clues to predict recovery from COVID- 19 induced respiratory failure, physicians should attempt to optimize respiratory status prior to gastrostomy tube placement, as ventilator dependence is associated with in-hospital mortality after gastrostomy placement. Families should be counseled that the majority of COVID-19 patients surviving the hospitalization will not require long-term gastrostomy tube feeding.(Table Presented)(Table Presented)
Keywords

Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Prognostic study Topics: Long Covid Language: English Journal: Gastroenterology Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Prognostic study Topics: Long Covid Language: English Journal: Gastroenterology Year: 2022 Document Type: Article