Readmission and Disposition in Patients With Malignant Bowel Obstructions Following Gastrostomy Tube

Author:

Yu Jingjing1ORCID,Sullivan Brittany G.1,Nguyen Ninh T.1,Hohmann Samuel F.2ORCID,Harris Alyssa H.2,Micic Dejan3,Turaga Kiran K.4,Senthil Maheswari1,Eng Oliver S.1

Affiliation:

1. Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA

2. Center for Advanced Analytics and Informatics, Vizient, Inc., Chicago, IL, USA

3. Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL, USA

4. Department of Surgery, Yale University, New Haven, CT, USA

Abstract

Background Patients with peritoneal carcinomatosis (PC) can develop malignant bowel obstructions (MBOs) requiring inpatient admission and nasogastric tube decompression. Palliative decompressive gastrostomy tubes (G-tubes) may affect patient disposition, allowing for self-management and reduction in inpatient services. Therefore, we sought to assess disposition and inpatient readmission rates in patients admitted with PC and MBO following G-tube placement. Methods The Vizient® Clinical Data Base was queried for inpatient admissions from October 2018 to May 2022 utilizing ICD-10 codes to identify patients admitted with PC and bowel obstruction, with or without G-tube placement. Demographics and hospital outcomes were recorded. Descriptive statistics and multivariate logistic regression analysis were performed. Results From 750 patients, 59 (7.9%) had a G-tube placed. Compared to patients without G-tubes, those with G-tubes had lower rates of disposition to home (32.2% vs 70.0%, P < .001) and higher rates of disposition to hospice (home: 30.5% vs 7.8%, P < .001, facility: 10.2% vs 3.9%, P = .02). There was no significant difference in the rate (17.3% vs 22.3%, P = .40) or risk (OR = 1.44, 95% CI .69-3.01) of 30-day readmissions with G-tubes. However, palliative care consultation (OR 33.77, 95% CI 19.16-59.52) and G-tube placement (OR 5.82, 95% CI 2.56-13.25) were independent predictors for hospice. Discussion Placement of G-tubes in patients with PC and MBO was associated with higher rates of disposition to hospice but there is no difference in 30-day readmission rates compared to those without G-tubes. Further prospective studies are needed to understand the role of G-tube placement in patients with MBO in relation to outcomes and disposition.

Publisher

SAGE Publications

Subject

General Medicine

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