Does Feeding Tube Insertion and Its Timing Improve Survival?

Abstract

Background/Objectives The objective of this study was to examine survival with and without a percutaneous endoscopic gastrostomy (PEG) feeding tube using rigorous methods to account for selection bias. A second objective was to examine whether the timing of feeding tube insertion affected survival. Design Prospective cohort study Setting All U.S. Nursing Homes Participants 36,492 nursing home residents with advanced cognitive impairment from dementia and new problems eating studied between 1999–2007. Measurements Survival following the development of the need for eating assistance and feeding tube insertion. Results Of the 36,492 nursing home (NH) residents (88.4% white, mean age 84.9, 87.4% with one feeding tube risk factor), 1,957 (5.4%) had a feeding tube inserted within 1 year of developing eating problems. After multivariate analysis correcting for selection bias with propensity score weights, no difference was found in the survival of the 2 groups (AHR 1.03, 95% CI 0.94–1.13). Among residents who were tube-fed, the timing of PEG tube insertion relative to the onset of eating problems was not associated with improved survival post feeding tube insertion (AHR 1.01, 95% CI 0.86–1.20) comparing those persons with a PEG inserted within a month of developing an eating problem compared to later (4 months) insertion. Conclusion This national study confirms that neither insertion of PEG feeding tubes nor the timing of the insertion improve survival.

Life-Sustaining Procedures, Palliative Care, and Cost Trends in Dying COPD Patients in U.S. Hospitals: 2005~2014

“…In contrast, other systemic procedures such as blood transfusion and nutrition decreased over time. These findings are consistent with recent reports identifying that restrictive red cell transfusion is not inferior to liberal transfusion except for heart disease (41) and that percutaneous gastrostomy tube feeding might not improve survival or aspiration pneumonia risks when compared to conservative approaches such as nasogastric tube feeding (42). Hospital cost increases over time in our analysis.…”

ESPEN guidelines on nutrition in dementia

“…A recent large prospective database analysis from Teno and colleagues [217] added valuable evidence confirming this statement. They evaluated minimal data set (MDS) information of 36,492 US nursing home residents with advanced dementia and newly developed eating problems.…”

“…When ANH is administered via a gastrostomy tube, physical restraints and their inherent risks are being applied more frequently. There is also a higher risk of aspiration pneumonia, diarrhea, gastrointestinal discomfort and pressure ulcers [206,217,226].…”

Contemporary acute care surgery percutaneous endoscopic gastrostomy tube placement

“…In patients whose swallow function is difficult or unsafe, PEG tube placement can be critical; in fact, in some patient, it may be the only effective means of obtaining long-term enteral nutrition. 8,13 In large-population studies, PEG feeding has not been shown to improve survival rates, 15 but it may improve the quality of life in older patients and in cancer patients. 16 Therefore, as a tool to improve the quality of life, it is absolutely essential for PEG tube placement to result in the least morbidity possible, to ensure that patients have the highest quality of life possible.…”