18OUTCOMES OF GASTROSTOMY INSERTIONS IN STROKE PATIENTS

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Abstract

Introduction: Dysphagia and subsequent gastrostomy feeding is common in patients with post-stroke. NCEPOD (2004) expressed concerns regarding patient selection for PEG insertions given 30-day mortality rates of 6% for all indications. The main aim of the survey was to look into mortality, complications post-gastrostomy, recovery of swallow and discharge destination following stroke and gastrostomy.

Method: Data were collected retrospectively for all the patients admitted to the Royal Liverpool University Hospital with a stroke and subsequent gastrostomy placement, throughout 2010 and 2011.

Results: Of 1,220 stroke patients, 53 (4%) had subsequent gastrostomies. The median age was 82, 36% were male. The median time from stroke to gastrostomy was 26 days. The mean length of stay for gastrostomy fed patients was 67 days, significantly higher than for all stroke patients (9.5 days). Mortality was 11% at 30 days post-gastrostomy, 30% at 90 days and 34% at 6 months.

Aspiration pneumonia post-gastrostomy insertion occurred in 45% of patients. Other less frequent complications were stoma site infection (6%), bleeding (4%), trauma (4%), blocked gastrostomy (2%) and leaking (2%).

At 6 months, six patients (11%) had their gastrostomy removed due to an improvement in their swallow. The median time to removal was 107 days.

Seventeen percent died before discharge from hospital, 62% were discharged to nursing homes/24-h care, and 19% were discharged to their own home. Of those discharged home, 50% had their gastrostomy removed.

Conclusions: Mortality and length of stay for gastrostomy fed stroke patients was higher compared with the total cohort, which is consistent with previous similar studies [James et al. (1998, Age Ageing, 27, 671–6]. Aspiration was the most common complication post-gastrostomy, and the majority of patients were discharged to nursing homes; however, half of those discharged home had their gastrostomy removed.

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