Safety of elective enteral access in elderly patients: a comparative analysis of perioperative risk

Abstract

BackgroundElderly patients can encounter torpid hospitalizations that are often characterized by malnutrition. In this setting, enteral feeding may facilitate improvement in nutritional status. The aim of this study is to compare perioperative outcomes of elderly (≥65 years-old) and non-elderly (<65 years-old) patients undergoing elective enteral access placement. MethodsAdult patients who underwent enteral access procedures between 2018-2020 at a tertiary care facility were reviewed retrospectively. Differences in baseline characteristics between non-elderly and elderly patients were adjusted using entropy-balanced weights. Subsequently, multivariable logistic and linear regressions were developed to evaluate the association between elderly status and outcomes of interest. Results914 patients with enteral access met inclusion criteria, of whom 471 (51.5%) were elderly. Compared to non-elderly patients, elderly individuals more commonly received percutaneous gastrostomy and had a higher burden of comorbidities as measured by the Charlson Index. Multivariable risk adjustment generated a strongly balanced distribution of baseline covariates between patient groups. After adjustment, despite no significant association with in-hospital mortality, reoperation, or time to goal feeds, elderly status was linked to an approximately 8-day reduction in length of stay (95%CI -14.28 to -2.30, p=0.007), as well as significantly lower odds of total parenteral nutrition (AOR 0.59, 95%CI 0.37-0.94, p=0.026) and non-elective readmission (AOR 0.65, 95%CI 0.49-0.86, p=0.003). Elderly status was also associated with significantly greater odds of non-home discharge (AOR 1.58, 95%CI 1.17-2.13, p=0.003). ConclusionDespite having more comorbidities than their non-elderly counterparts, elderly patients experienced favorable nutritional and perioperative outcomes after enteral access placement.