Predictive Factors for Percutaneous Endoscopic Gastrostomy Tube Placement After Anterior Cervical Fusion

Study Design: Retrospective case-control study. Objectives: To identify incidence and risk factors for percutaneous endoscopic gastrostomy (PEG) tube placement after anterior cervical fusion (ACF). Methods: Adult patients undergoing elective ACF with/without corpectomy for spondylosis from 2002 to 2011 were identified using the Nationwide Inpatient Sample database. The primary outcome measure was PEG tube placement; secondary outcomes included in-hospital mortality, total hospital charges, and discharge disposition. Multiple regression analyses were conducted to identify independent predictors of PEG tube placement. Results: Of 164 097 patients, 217 (0.13%) required a PEG tube. Patients needing PEG tube placement were older (69 vs 52 years; P <.001) and more likely to be male (65% vs 46.6%; P <.001) when compared with control patients. After regression analysis, age over 65 year (odds ratio [OR] = 4.16; P <.001) was the strongest independent predictor for PEG tube placement; other associated factors included male gender (OR = 2.14; P <.001), congestive heart failure (OR = 4.11; P <.001), anemia (OR = 3.52; P <.001), alcohol abuse (OR = 2.80; P =.009), renal failure (OR = 2.25; P =.003), chronic lung disease (OR = 1.78; P <.001), corpectomy (OR = 2.16; P <.001), and fusion of ≥3 segments (OR = 1.74; P <.001). Mortality rate for patients requiring PEG tube placement was 5.1% versus 0.05% for controls (P <.001); average hospital charges were $134 379 versus $39 519 (P <.001), and nonroutine discharges were seen in 89.3% versus only 6.4% for controls (P <.001). Conclusions: The incidence of PEG tube placement after ACF was 0.13% in this study. Identified risk factors included age >65, corpectomy, fusion of ≥3 segments, and various comorbidities. Additionally, there may be increased risk of in-hospital mortality, hospital charges, and nonroutine discharges among these patients.