Peritonitis from peg tube insertion in surgical intensive care unit patients: identification of risk factors and clinical outcomes

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tubes are routinely inserted in the surgical intensive care unit (SICU). Poor tissue healing or technical issues after tube insertion can lead to peritonitis requiring a laparotomy. This study aimed to identify risk factors leading to peritonitis. METHODS: A retrospective study reviewed of PEG tubes inserted in SICU patients from 2003 to 2006. Age, sex, body mass index (BMI), organ dysfunction, vasopressor use, fluid balance, steroid use for medical reasons, and nutritional status of the patients were noted. The patients with acute spinal cord injury who received high-dose steroids were excluded from the study. Mortality and peritonitis requiring laparotomy were the outcomes. Logistic regression performed with SAS version 9.1 (Cary, NC) was used for analysis. RESULTS: Of 322 patients, 16 (5%) required a laparotomy for peritonitis, and 74 (23%) died during the hospital stay. The major predictors of the need for a laparotomy were higher BMI (p = 0.0005) and a serum albumin level lower than 2.5 gm/dL (p = 0.0008). Patients with both a BMI exceeding 30 kg/m(2) and an albumin level lower than 2.5 gm/dL were 25 times more likely to need a laparotomy (95% confidence interval [CI], 7.74-83.3). The mean time from tube placement to laparotomy was 11 days. Of the 16 patients who required laparotomy, 9 died during the hospitalization. Patients requiring a laparotomy were five times more likely to die during the hospitalization than patients not requiring a laparotomy (p = 0.004; 95% CI, 1.68-13.07). The mean time from laparotomy to death was 23 days. Signs of sepsis and worsening abdominal examination developed in all 16 laparotomy patients. Dislodged tube with gastric wall not opposed to the abdominal wall was the most common finding at laparotomy. CONCLUSION: Approximately 5% of patients undergoing PEG insertion in the SICU require laparotomy for peritonitis and are more likely to die during the hospitalization. Higher BMI and a lower serum albumin level, by contributing to poor healing, increase the risk of peritonitis.