Abstract P265: Percutaneous Endoscopic Gastrostomy in Patients Discharged After Stroke in Washington State

Abstract

OBJECTIVE: Explore the use of percutaneous endoscopic gastrostomy (PEG) in patients discharged after hospitalization for stroke in Washington State (WA). METHODS: Patients were identified from administrative data for WA hospitals and included those discharged between 1995 and 2008 with stroke ICD-9 codes. PEG was defined by the presence of ICD-9 procedure codes. Using multivariate logistic regression, we sought independent associations with PEG for age, gender, stroke type, intubation, discharge year, co-morbid conditions, urban vs. rural home, and hospital type (stroke center or not). RESULTS: A total of 118,785 stroke patients were discharged alive, 88% ischemic, 8% intracerebral hemorrhage (ICH), and 4% subarachnoid hemorrhage (SAH). Mean age was 73 years (SD 14), 54% were women, 44% were admitted to a stroke center, and 4.1% had PEG. Other complications of stroke included hemiplegia (28%), pneumonia (8%), and intubation (2%). Patient residence was urban for 83% and rural for 17%. Significant (p < 0.0001) independent associations with PEG included older age (OR ranging from 1.1, 95% CI .96-1.2, to 1.4, 95% CI 1.3-1.6, depending on age group), intubation (2.6, 2.3-2.9), hemiplegia (2.3, 2.1-2.4), stroke type (vs. ischemic stroke: ICH 2.0, 1.8-2.2; SAH 1.6, 1.3-1.8), atrial fibrillation (1.4, 1.3-1.5), congestive heart failure (1.2, 1.1-1.3), acute myocardial infarction (1.2, 1.0-1.4), pneumonia (6.0, 5.6-6.4), stroke center (1.1, 1.1-1.2), and rural home address (.76, .70-.83). PEG was not associated with discharge time period, but this effect was modified by eventual stroke center status (p < 0.0001). CONCLUSIONS: In this large population-based study, we found a lower frequency of PEG in stroke survivors than previously reported, possibly reflecting misclassification in our study, selection bias in prior studies, or both. PEG was significantly associated with stroke type and medical complications, particularly pneumonia and endotracheal intubation, likely reflecting stroke severity. The rising probability of PEG at stroke centers may suggest that severely affected patients are increasingly being transferred to stroke centers. Additional studies are need to understand better the criteria for and the utility of PEG in stroke survivors.