Trends and outcomes associated with gastrostomy tube placement in common neurodegenerative disorders

https://doi.org/10.1016/j.prdoa.2020.100088Get rights and content
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Highlights

  • Rate of gastrostomy tube down trended during the study period.

  • Thousands of patients are still undergoing gastrostomy tube placement.

  • Gastrostomy tube is associated with longer hospital stay.

  • Gastrostomy tube is associated with a higher odds of discharge to nursing facility.

Abstract

Introduction

Dysphagia causing aspiration pneumonia is a common complication in the advanced stages of neurodegenerative disorders. Historically, physicians attempted to prevent this complication with gastrostomy tube (GT) placement. Its use is supported in amyotrophic lateral sclerosis (ALS), not supported in Alzheimer’s disease (AD), and without disease-specific guidelines in Parkinson’s disease (PD).

Method

The rate of GT placement in these three populations over two decades, from 1990 to 2010, was calculated using a binomial regression model with the data extracted using diagnosis and procedural codes from a national database. The median length-of-stay (LOS) and discharge destinations were compared.

Results

The rate of GT placement was 6.0% lower annually in AD, 3.4% in PD, and 0.2% in ALS (all p ≤ 0.007). The analysis of hospital LOS and discharge destination showed 3.2 to 5.5 days longer LOS with GT placement in all groups (all p ≤ 0.01), and three to four times lower odds of going home with GT placement in AD and PD groups (OR 0.28, 95% CI 0.14–0.55, and OR 0.22, CI 0.11–0.42 respectively), while unchanged in ALS group (OR 1.1, 95% CI 0.6–1.9).

Conclusion

Despite the downward trend of GT placement over two decades, thousands of AD and PD patients still underwent GT placement annually, and this was associated with longer LOS in all groups and increased likelihood of being discharged to a nursing facility in AD and PD. Further research is necessary to understand the effects of GT on physician practices and patient expectations in advanced AD and PD.

Keywords

Neurodegenerative diseases
Alzheimer’s disease
Parkinson’s disease
Amyotrophic lateral sclerosis
Gastrostomy tube
Palliative care

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