Nasal Feeding Tubes are Associated with Fewer Adverse Events than Feeding via Ostomy in Hospitalized Patients Receiving Enteral Nutrition

Abstract

Background: Surgical feeding ostomies (SFO, e.g. gastrostomy) have replaced natural orifice feeding tubes (NOFT, e.g. nasogastric feeding tube) as the preferred route for long-term enteral nutrition. Reports of complication rates for SFO vary. Many hospitalized patients are required to accept SFO before hospital discharge due to skilled nursing facilities (SNFs) policy, and without supportive data. We compare adverse event rates between SFO and NOFT. Methods: A prospective cohort study of enterally fed inpatients using semiweekly focused physical exam, scripted survey, and chart review. Findings: Over the course of nine weeks, 226 unique patients were seen an average of 6.25 times each for a total of 1118 unique observations. Demographic data were comparable between subgroups. There were 148 subjects with NOFT and 113 subjects with SFO. 35 NOFT crossed over to SFO during the study. More NOFT than SFO observations took place in ICUs (p<0.001). SFO were associated with higher incidence of adverse events than NOFT (3.34 versus 1.25 events per 100 subject days, p<0.001). Overall there was a documentation rate of 50% of all adverse events, with no difference by feeding tube. More SFO patients were discharged to skilled nursing facilities than NOFT patients (58% versus 24%). Interpretation: Our study supports previous findings that SFO is associated with higher in-hospital adverse events rates than NOFT. Additionally, a substantial number of subjects with SFO were discharged to skilled nursing facilities. Surgical feeding ostomies have replaced natural orifice feeding tubes as the preferred route for long-term enteral nutrition. In the present study, we found that NOFT is associated with fewer and less serious adverse events when compared to SFO in patients receiving in-hospital enteral feeding. Our findings suggest SFO should be reevaluated as the preferred method for tube feeding in adults anticipated to require enteral nutrition on hospital discharge. Funding Statement: National Heart, Lung, and Blood Institute (Burgermaster—training grant T32 HL 7343‐37). Declaration of Interests: None declared. Ethics Approval Statement: Subjects and/or family members were told about the nature of the study and asked verbally for their willingness to participate. The study protocol was approved by the Columbia University Medical Center Institutional Review Board (IRB protocol number AAAM2257).