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Open Access
CC BY 4.0 · Journal of Digestive Endoscopy
DOI: 10.1055/s-0045-1812504
Original Article

Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement in Frail Patients: Exploring Postprocedural Outcomes and Readmissions Using the National Readmission Database, 2018–2020

Authors

  • Madhav Changela 

    1   Department of Internal Medicine, One Brooklyn Health System/Interfaith Medical Center, Brooklyn, New York, United States

  • Maulik Kaneriya 

    1   Department of Internal Medicine, One Brooklyn Health System/Interfaith Medical Center, Brooklyn, New York, United States

  • Ernestine Faye Tan 

    1   Department of Internal Medicine, One Brooklyn Health System/Interfaith Medical Center, Brooklyn, New York, United States

  • Janak Bahirwani 

    2   Department of Gastroenterology, Kadlec Regional Medical Center, Richland, Washington, United States

  • Vaishnavi Mahendrasinh Rathod 

    1   Department of Internal Medicine, One Brooklyn Health System/Interfaith Medical Center, Brooklyn, New York, United States

  • Nishit Patel 

    3   Department of Gastroenterology, St Luke's University Health Network, Bethlehem, Pennsylvania, United States

  • Krishna Bodrya 

    4   Department of Internal Medicine, Leigh Valley Health Network, Easton, Pennsylvania, United States

  • Rohan Hehr 

    5   Department of Gastroenterology, One Brooklyn Health-Brookdale University Hospital Medical Center, Brooklyn, New York, United States

  • Juhi Ardeshna Chovatiya 

    6   Department of Internal Medicine, Riverside School of Medicine, University of California, Riverside, California, United States

  • Kalpana Panigrahi

    1   Department of Internal Medicine, One Brooklyn Health System/Interfaith Medical Center, Brooklyn, New York, United States

  • Muhammad Hasan

    1   Department of Internal Medicine, One Brooklyn Health System/Interfaith Medical Center, Brooklyn, New York, United States

Funding None.
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Abstract

Objective

Percutaneous endoscopic gastrostomy (PEG) tube placement is a common gastrointestinal procedure that provides nutrition, fluids, and medications to patients with inadequate oral intake. A substantial proportion of patients undergoing PEG tube placement are frail. This study compares mortality, morbidity, and 30-day hospital readmission rates between frail and nonfrail patients undergoing PEG tube placement.

Materials and Methods

We conducted a retrospective analysis using data from the National Readmission Database for 2018 to 2020. The study included all patients aged ≥ 18 years who underwent PEG tube placement. Patients were stratified into two groups based on frailty, defined using the Johns Hopkins Adjusted Clinical Groups Frailty Indicator. Primary outcomes were mortality and all-cause 30-day readmission rates. Secondary outcomes included length of stay (LOS), total hospitalization charges, and inpatient complications such as sepsis and aspiration pneumonia.

Statistical Analysis

A multivariate regression model was used to estimate clinical outcomes between the two cohorts after adjusting for potential confounders.

Results

A total of 419,313 patients underwent PEG tube placement, among whom 278,564 (66.43%) were frail. Frail patients had higher mortality (p = 0.003), longer LOS, and higher all-cause readmission rates than nonfrail patients. Rates of gastric perforation and intraprocedural puncture/laceration were lower in frail patients. The most common causes of 30-day readmission were sepsis (53.14%), pneumonitis due to inhalation of food and vomit (15.55%), gastrostomy malfunction (6.13%), acute kidney failure (3.38%), and pneumonia, unspecified organism (3.97%). Independent predictors of all-cause readmission included frailty, age, Charlson Comorbidity Index, hospital bed size, and insurance, all statistically significant.

Conclusion

Frail patients undergoing PEG tube placement have higher mortality, morbidity, and readmission burden. These findings highlight the need for caution when performing PEG tube placement in frail patients. Further research is warranted to validate these findings.

Keywords

percutaneous endoscopic gastrostomy (PEG) tube - frailty - mortality - hospital readmission rate - morbidity - Johns Hopkins Adjusted Clinical Groups (ACG) Frailty Indicator

Ethical Approval

This study was conducted using deidentified, publicly available data and was therefore exempt from institutional review board (IRB) approval. All data were handled in accordance with ethical standards for research involving human subjects.


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Publication History

Article published online:
30 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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