Timing of Percutaneous Endoscopic Gastrostomy for Acute Ischemic Stroke

Dysphagia, or difficulty swallowing, is a common occurrence after stroke, occurring in ≥65% of stroke patients. About half of the patients with dysphagia improve within 2 weeks and 15% continue to have persistent dysphagia after 1 month. Prior studies evaluating early percutaneous endoscopic gastrostomy (PEG) feeding compared with nasogastric feeding and delayed PEG< if needed, have shown that there was no benefit and, possibly, a borderline increase in the absolute risk of death or poor outcome with a policy of early PEG placement (48% within 3 days) compared with early nasogastric feeding followed by PEG if needed. Because of this and the limited data available to predict outcomes among dysphagic stroke patients, providers often use time-limited trials of artificial nutrition. The American Stroke Association Guidelines for the Early Management of Patients With Acute Ischemic Stroke recommend nasogastric feeding over PEG tube feeding for a period of ≥2 to 3 weeks after stroke onset. Prior studies have found significant variation in the surgical placement of feeding tubes after stroke, with many hospital factors influencing the decision to place a PEG tube. However, little is known about the current practices in time to PEG tube placement for stroke admissions and which factors may impact the timing of PEG placement. In the setting of health system pressures to reduce length of stay and maintain efficiency, we hypothesized that many patients receive their PEG tubes early on in their hospital stay. We sought to describe the timing of surgical feeding tube placement for patients hospitalized for acute ischemic stroke, to identify characteristics associated with early PEG tube placement, and to assess variability between hospital practices in timing of PEG placement.