Abstract P215: Declining Gastrostomy Tube Utilization in Acute Ischemic Stroke

Abstract

Objective: To test the hypothesis that placement of percutaneous feeding tubes (PEG) in acute ischemic stroke (AIS) patients has declined following increased usage of intravenous thrombolysis (IV-tPA) and mechanical thrombectomy (MT) over the last decade. Methods: We identified all primary adult AIS admissions contained in the 2005-2017 National Inpatient Sample using International Classification of Diseases (ICD) codes. Age and sex-specific proportions of hospitalizations with coexisting ICD procedural codes for PEG were computed. Joinpoint regression was used to evaluate trends over time. Multivariable adjusted logistic regression was used to compare odds of PEG use between periods and demographic subgroups. Results: From 2005-2017, 4.3% of all AIS hospitalizations had coexisting codes for PEG but usage differed by age, with highest proportion of usage in patients >=80 year old (y.o) (5.2%) and lowest frequency of usage in adults 18-39 y.o (2.7%). On joinpoint regression, there was no significant change in PEG use from 2005-2009, usage declined annually by -3.0% from 2009-2015 (95%CI -4.2% to -1.8%) and then declined sharply by -9.2% (95%CI -13.4 to -4.8%) from 2015 to 2017 (figure 1). The pace of decline was faster in patients >=80y.o compared to other age groups. After multivariable adjustment for clinical and hospital level factors, patients hospitalized in the period 2014-2017 had 25% reduced odds of PEG when compared to admissions in the period 2005-2009 (OR 0.76, 95%CI 0.72-0.79). Female sex and white race were associated with lower odds of PEG compared to males and black patients, respectively. IV-tPA and MT usage increased over time with marked increase in usage after 2015. Conclusion: Overall the rate at which PEG tube have been utilized has decreased significantly over the last decade. This decrease is likely from multifactorial advances in acute stroke (IV-tPA and MT) and post stroke neuro critical care.