A propensity-matched analysis of the impact of early and late percutaneous endoscopic gastrostomy tube placement among patients with significant comorbidities.

Abstract

Percutaneous endoscopic gastrostomy tubes offer a reliable method for long-term enteral nutrition, with current guidelines recommending placement within 14 days. There is limited research evaluating the potential benefits of extending the timeline for percutaneous endoscopic gastrostomy tube insertion to allow for increased clinical flexibility. This study evaluated percutaneous endoscopic gastrostomy tube placement timing on post-percutaneous endoscopic gastrostomy hospital length of stay and determined whether an extended threshold maintains clinical benefit. A retrospective cohort study was conducted at a tertiary academic medical center. Patients undergoing percutaneous endoscopic gastrostomy placement were identified via the International Classification of Diseases, Tenth Revision codes. The primary outcome was post-percutaneous endoscopic gastrostomy length of stay. Secondary analysis included threshold detection using cubic regression modeling. Propensity-matched and multivariable models incorporated covariates, such as the Charlson Comorbidity Index, age, and gender. One hundred forty-seven patients underwent elective percutaneous endoscopic gastrostomy placement; 105 received percutaneous endoscopic gastrostomy placement within 22 days of admission, and 42 underwent placement beyond 22 days. Thresholding analysis identified 22 days as the upper limit for a statistically significant difference in postoperative length of stay. Patients receiving percutaneous endoscopic gastrostomy tubes after 22 days exhibited a significantly longer postoperative length of stay compared with those receiving earlier placement (12 vs 25 days; P < .0001). Charlson Comorbidity Index, age, and gender were not significant predictors of postoperative length of stay and did not differ between the cohorts. Early percutaneous endoscopic gastrostomy tube placement is associated with reduced post-percutaneous endoscopic gastrostomy length of stay. Clinical guidelines may be safely adapted to allow percutaneous endoscopic gastrostomy placement till 22 days postadmission without compromising length of stay significantly. This extended window may offer greater flexibility in individualized patient care while maintaining clinical and financial efficiency.