Hospital Readmissions of Stroke Patients with Percutaneous Endoscopic Gastrostomy Feeding Tubes

Abstract

Objectives A critical mission of acute care hospitals is to reduce hospital readmissions to improve patient care and avoid monetary penalties. We speculated that stroke patients with enteral tube feeding are high-risk patients and sought to evaluate their hospital readmissions. Methods We analyzed archival hospital billing data from stroke patients discharged from acute care hospitals in Florida in 2012 for 30- and 60-day readmission rates, 30-day readmission rates by discharge destination, most frequent primary readmission diagnoses, and predictors of 30-day readmissions. We conducted univariate and multivariable logistic regression analyses. Results We analyzed 26,774 discharge records. Within 30 days after discharge, 21.06% (N = 299) of stroke patients with percutaneous endoscopic gastrostomy (PEG) tube placement were rehospitalized. Of those readmissions, 11.71% (N = 35) were preventable. Among stroke patients with a PEG tube placement, 53.80% were discharged to skilled nursing facilities and 27.88% were rehospitalized within 30 days. Septicemia was the most frequent primary readmission diagnosis. Comorbidities, stroke type, length of hospital stay, and discharge destinations were predictive for 30-day readmissions (area under the receiver operating characteristic curve was .81). Conclusions Stroke patients with a PEG tube placement during their index hospital stay are twice as likely to be readmitted within 30 days compared to stroke patients without PEG tube placements. The primary readmission diagnosis for some patients was directly linked to PEG tube complications. We have identified risk factors that can be used to focus resources for readmission prevention.

Timing of Percutaneous Endoscopic Gastrostomy for Acute Ischemic Stroke

“…Prior studies have found a greater likelihood of PEG tube complications and hospital readmissions with advanced age. 8 Also, from the FOOD trials (Feed or Ordinary Diet), a comparison of early feeding via PEG versus nasogastric tube and delayed PEG, if needed, demonstrated that early PEG feeding was associated with a borderline increased risk of death or poor outcome.…”

Impact of Gastrostomy Feeding Tube Placement on the 1‐Year Trajectory of Care in Patients After Stroke

“…Reducing hospital readmissions is not only a main incentive of acute care hospitals who are penalized for 30‐day readmissions through the Medicare Hospital Readmission Reduction Program but also in the interest of patients because readmissions are a surrogate for quality of care. Although several factors other than PEG tube placement may contribute to hospital readmissions in stroke patients, we found in a previous study that PEG tube placement was an independent risk factor for hospital readmissions in stroke patients …”

“…Besides discharge location, number of comorbidities, hospital length of stay (LOS), and stroke type were predictive for 30‐day readmissions. To the best of our knowledge, this is the only study that assessed hospital readmissions of stroke patients with PEG tube placement and that identified opportunities to prevent future readmissions . Our findings emphasize that stroke patients with a PEG tube are at risk for hospital readmissions because of clinically significant postacute care complications.…”

“…Our previous research has shown that stroke patients who receive a PEG tube during their acute hospital stay are twice as likely to be readmitted within 30–60 days to an acute care hospital when compared with stroke patients who did not receive a PEG tube . For some patients, the primary medical reason of their hospital readmission was directly linked to their PEG tube.…”

Race Differences in Gastrostomy Tube Placement After Stroke in Majority-White, Minority-Serving, and Racially Integrated US Hospitals

“…Major life-threatening complications occur in up to 3%[5,6]. In addition, PEG placement after stroke may be associated with increased early readmission rates, poor long-term outcomes, and mortality[7–10]. …”