Journal article
A selective placement strategy for surgical feeding tubes benefits trauma patients
The journal of trauma and acute care surgery, Vol.85(1), pp.135-139
01 Jul 2018
PMID: 29521796
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUND The indications for surgical feeding tube (SFT) placement in trauma patients are poorly defined. Patient selection is critical as complications from SFTs have been reported in up to 70% of patients. A previous analysis by our group determined that 25% of the SFTs we placed were unnecessary and that older patients, patients with head and spinal cord injuries, and patients who needed a tracheostomy were more likely to require long-term SFTs. Following this study, we modified our institutional guidelines for SFT placement. We hypothesized that a more selective placement strategy would result in fewer unnecessary SFTs.
METHODS A retrospective review of all adult patients from 2012 to 2016 with an intensive care unit length of stay longer than 4 days and an SFT placed during admission was conducted. This group was compared to data collected prior to our change in practice (2007-2010). Data from 2011 were excluded as a washout period. Necessary SFT use was defined per established guidelines as either daily use of the SFT through discharge or for 28 days or longer and unnecessary SFT use as all others.
RESULTS Two hundred fifty-seven SFTs were placed from 2007 to 2010 and 244 from 2012 to 2016. Following implementation of our selective SFT placement strategy, unnecessary SFT placement decreased from 25% in 2007 to 2010 to 8% in 2012 to 2016 (p < 0.0001). Significant predictors of necessary SFT placement by univariate regression were as follows: increasing age (odds ratio [OR] 1.03/year; 95% confidence interval [CI], 1.01-1.04), head injury (OR, 2.80; 95% CI, 1.71-4.60), cervical spinal cord injury (OR, 4.42; 95% CI, 1.34-14.50), and need for tracheostomy (OR, 1.41; 95% CI, 2.21-7.67). The overall complication rate was 11% (9% in the selective group vs. 13% in the preselective group, p = 0.2574) and was highest following open SFT placement (22%).
CONCLUSION A selective placement strategy for SFTs in our trauma population resulted in fewer unnecessary SFTs and a trend toward fewer complications. Surgical feeding tubes should be placed through a percutaneous approach whenever possible.
LEVEL OF EVIDENCE Therapeutic study, level IV.
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Details
- Title
- A selective placement strategy for surgical feeding tubes benefits trauma patients
- Creators
- Joseph Marcotte - Cooper University HospitalJoshua P. Hazelton - Cooper University HospitalChirag Arya - Cooper University HospitalMichael Dalton - Jefferson CollegeAmber Batool - Cooper University HospitalJohn Gaughan - Cooper University HospitalLinh Nguyen - Cooper University HospitalJohn Porter - Cooper University HospitalNicole Fox - Cooper University Hospital
- Publication Details
- The journal of trauma and acute care surgery, Vol.85(1), pp.135-139
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 5
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000437457000020
- Scopus ID
- 2-s2.0-85061984445
- Other Identifier
- 991022056903004721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Critical Care Medicine
- Surgery