Enteral Access Outcomes in Patients Hospitalized With Cardiac Disease: A Retrospective Cohort Study

Armaun D Rouhi; Jeffrey L Roberson; Angelika N Alberstadt; Simrin Kesmia Shah; Madeline Maurer; Elizabeth Bader; Noel N Williams; Kristoffel R Dumon

doi:10.1016/j.jss.2024.04.005

Enteral Access Outcomes in Patients Hospitalized With Cardiac Disease: A Retrospective Cohort Study

J Surg Res. 2024 May 2:299:43-50. doi: 10.1016/j.jss.2024.04.005. Online ahead of print.

Authors

Armaun D Rouhi¹, Jeffrey L Roberson¹, Angelika N Alberstadt¹, Simrin Kesmia Shah¹, Madeline Maurer¹, Elizabeth Bader¹, Noel N Williams¹, Kristoffel R Dumon²

Affiliations

¹ Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
² Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Kristoffel.Dumon@pennmedicine.upenn.edu.

PMID: 38701703
DOI: 10.1016/j.jss.2024.04.005

Abstract

Introduction: Patients admitted with principal cardiac diagnosis (PCD) can encounter difficult inpatient stays that are often marked by malnutrition. In this setting, enteral feeding may improve nutritional status. This study examined the association of PCD with perioperative outcomes after elective enteral access procedures.

Methods: Adult patients who underwent enteral access procedures between 2018 and 2020 at a tertiary care institution were reviewed retrospectively. Differences in baseline characteristics between patients with and without PCD were adjusted using entropy balancing. Multivariable logistic and linear regressions were subsequently developed to evaluate the association between PCD and nutritional outcomes, perioperative morbidity and mortality, length of stay, and nonelective readmission after enteral access.

Results: 912 patients with enteral access met inclusion criteria, of whom 84 (9.2%) had a diagnosis code indicating PCD. Compared to non-PCD, patients with PCD more commonly received percutaneous endoscopic gastrostomy by general surgery and had a higher burden of comorbidities as measured by the Charlson comorbidity index. Multivariable risk adjustment generated a strongly balanced distribution of baseline covariates between patient groups (standardized differences ranged from -2.45 × 10^-8 to 3.18 × 10⁸). After adjustment, despite no significant association with in-hospital mortality, percentage change prealbumin, length of stay, or readmission, PCD was associated with an approximately 2.25-day reduction in time to meet goal feeds (95% CI -3.76 to -0.74, P = 0.004) as well as decreased odds of reoperation (adjusted odds ratio 0.28, 95% CI 0.09-0.86, P = 0.026) and acute kidney injury (adjusted odds ratio 0.24, 95% CI 0.06-0.91, P = 0.035).

Conclusions: Despite having more comorbidities than non-PCD, adult enteral access patients with PCD experienced favorable nutritional and perioperative outcomes.

Keywords: Cardiac; Enteral feeding; Enteral nutrition; Gastrostomy; Jejunostomy; Outcomes.