Abstract Details

Title Feeding tube dependence among older stroke patients with feeding tubes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P18 - Poster Session 18 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-001

Background

Feeding tubes are intended to reduce aspiration and improve nutrition among patients with dysphagia post-stroke. Outcomes particularly relevant to older stroke patients, including time to feeding tube removal, are not well-understood.

Objective

To describe the clinical course of older stroke patients discharged with feeding tubes, and among patients admitted to a skilled nursing facility (SNF), identify patient and SNF factors associated with feeding tube removal.

Design/Methods Medicare Part A files identified subjects age 65 and older, hospitalized with ischemic stroke from 2012-2017, with feeding-tube inserted during stroke hospitalization. Among patients admitted to SNF, Minimum Data Set (MDS) assessments indicated feeding tube removal, discharge home, and mortality or hospice at 90-days, and 1-year. Multivariable Cox regression identified patient and SNF factors associated with longer time to feeding tube removal, discharge home, and mortality or hospice.

Results There were 50,861 subjects admitted to SNFs with feeding tubes after ischemic stroke hospitalization. At 90-days, 13% returned home, 28% had died, and 42% remained in a SNF. At 1-year, 18% returned home, 45% had died, and 14% remained in a SNF. Feeding tube removal occurred among 23% and 46% of patients at 90-days and 1-year respectively. Multivariable analyses revealed greater cognitive or functional impairment, and lower body mass index at the time of SNF admission were associated with longer time to feeding feeding tube removal. SNF characteristics associated with longer time to feeding tube removal included lower quality rating (adjusted hazard ratio (aHR) 0.95, 95% confidence interval (CI) 0.91-0.98), non-hospital based facility (aHR 0.80, 95% CI 0.64-0.88), and urban (versus rural) locations (aHR 0.88, 95% CI 0.84-0.92).

Conclusions Most older patients with feeding tubes inserted post stroke remain feeding tube dependent at 90-days, and nearly half die within 1-year. Nursing home quality is a key modifiable factor for improving the care of older stroke patients with feeding tubes.

Authors/Disclosures
Corey R. Fehnel, MD, FAAN (Beth Israel Deaconess Medical Center) PRESENTER	Dr. Fehnel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for XRHealth. The institution of Dr. Fehnel has received research support from National Institute on Aging .
	No disclosure on file
	No disclosure on file
Sandeep Kumar, MD	Dr. Kumar has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for CRICO.
	No disclosure on file
	No disclosure on file
	No disclosure on file