Does feeding tube insertion and its timing improve survival?

Abstract

Objectives: To examine survival with and without a percutaneous endoscopic gastrostomy (PEG) feeding tube using rigorous methods to account for selection bias and to examine whether the timing of feeding tube insertion affected survival.

Design: Prospective cohort study.

Setting: All U.S. nursing homes (NHs).

Participants: Thirty-six thousand four hundred ninety-two NH residents with advanced cognitive impairment from dementia and new problems eating studied between 1999 and 2007.

Measurements: Survival after development of the need for eating assistance and feeding tube insertion.

Results: Of the 36,492 NH residents (88.4% white, mean age 84.9, 87.4% with one feeding tube risk factor), 1,957 (5.4%) had a feeding tube inserted within 1 year of developing eating problems. After multivariate analysis correcting for selection bias with propensity score weights, no difference was found in survival between the two groups (adjusted hazard ratio (AHR) = 1.03, 95% confidence interval (CI) = 0.94-1.13). In residents who were tube-fed, the timing of PEG tube insertion relative to the onset of eating problems was not associated with survival after feeding tube insertion (AHR = 1.01, 95% CI = 0.86-1.20, persons with a PEG tube inserted within 1 month of developing an eating problem versus later (4 months) insertion).

Conclusion: Neither insertion of PEG tubes nor timing of insertion affect survival.

Figure 1. Adjusted Survival Time Among Those With and Without a Feeding Tube Insertion

This survival curve compares the one-year survival from the MDS that noted assistance in eating among those residents with and without a PEG feeding tube inserted.

Figure 2. Adjusted Survival Time after Feeding Tube Insertion Stratified by Timing of Feeding Tube Insertion From Development of CPS Score of 6

Among those with a feeding tube, the one year survival from feeding tube insertion is depicted in 4 adjusted survival curves that include cohort of persons who had the feeding tube inserted one (n=569), two (n=310), three (n=205), and 4 or more months (n=872) after the NH resident need for eating assistance.