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High Mortality in Gastrostomy Patients.

The availability of percutaneous endoscopic gastrostomy tubes since the early 1980s has led to a marked increase in feeding tube placement in elderly hospitalized patients. But are gastrostomies improving outcomes? This study examined retrospective survival data for 80,108 Medicare patients who in 1991 received gastrostomies, of which 59,969 were percutaneous placements.

The most common primary diagnoses were cerebrovascular disease (18 percent) and neoplasms (9 percent). The cumulative mortality after gastrostomy was 15 percent in-hospital, 24 percent at 30 days, 63 percent at one year, and 81 percent at three years. Short-term mortality rates were particularly high for patients with pneumonia, congestive heart failure, or neoplasms.

Comment: Although enteric feeding can be lifesaving in certain medical conditions, these data confirm that gastrostomies are often placed in patients with very poor prognoses. As the authors note, many enterally-fed patients "are not dying because of lack of nutrition, but rather lack the need to eat because they are dying." Gastrostomy should be considered only in the context of larger discussions with patients and families about the aggressiveness of care.

— TH Lee

Published in Journal Watch General Medicine July 7, 1998

Citation(s):

Grant MD et al. Gastrostomy placement and mortality among hospitalized Medicare beneficiaries. JAMA 1998 Jun 24 279 1973-1976.

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