Gastrostomy tube placement: An opportunity for establishing patient-centered goals of care

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Abstract

Background.

Surgeons and other health care providers are frequently consulted for gastrostomy tube placement in seriously ill patients at risk of outcomes poorly aligned with patient goals. Palliative care assessments have been recommended to guide decision-making in this setting. We aimed to characterize patient-centered outcomes and define the extent of unmet palliative care need in patients receiving gastrostomy tubes.

Methods.

This is a retrospective study of all adult, nontrauma inpatients who underwent gastrostomy tube placement over 16 months at an urban academic medical center. Outcomes included in-hospital and 1-year mortality, functional status at discharge, and receipt of palliative care assessment preprocedure.

Results.

Gastrostomy tubes were placed in 205 patients. In-hospital and 1-year mortality rates were 8% and 19%, respectively. Of patients surviving to discharge, 69% were unable to live independently. Among patients with acute brain injury or respiratory failure, 90% died in the hospital or were severely disabled at discharge. Only 12% of patients received a documented palliative care assessment preprocedure.

Conclusion.

Given high risks of mortality and poor functional outcomes, consideration of gastrostomy tube placement is an appropriate but underutilized trigger for palliative care assessment. This study highlights an untapped opportunity to optimize the goal concordance of treatment in operative intervention.

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