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.
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.
Authors: Timothy S Carey; Laura Hanson; Joanne M Garrett; Carmen Lewis; Nancy Phifer; Christopher E Cox; Anne Jackman Journal: Am J Med Date: 2006-06 Impact factor: 4.965
Authors: Lauren H Nicholas; Julie P W Bynum; Theodore J Iwashyna; David R Weir; Kenneth M Langa Journal: Health Aff (Millwood) Date: 2014-04 Impact factor: 6.301