Current practices in feeding tube placement for US acute ischemic stroke inpatients

Benjamin P. George, Adam G. Kelly, Eric B. Schneider, Robert G. Holloway

Research output: Contribution to journalArticle

Abstract

Objective: We sought to identify current US hospital practices for feeding tube placement in ischemic stroke. Methods: In a retrospective observational study, we examined the frequency of feeding tube placement among hospitals in the Nationwide Inpatient Sample with ≥30 adult ischemic stroke admissions annually with length of stay greater than 3 days. We examined trends from 2004 to 2011 and predictors using data from more recent years (2008-2011). We used multilevel multivariable regression models accounting for a hospital random effect, adjusted for patient-level and hospital-level factors to predict feeding tube placement. Results: Feeding tube insertion rates did not change from 2004 to 2011 (8.1 vs 8.4 per 100 admissions; p trend = 0.11). Among 1,540 hospitals with 164,408 stroke hospitalizations from 2008 to 2011, a feeding tube was placed 8.8% of the time (n = 14,480). Variation in the rate of feeding tube placement was high, from 0% to 26% between hospitals (interquartile range 4.8%-11.2%). In the subset with available race/ethnicity data (n = 88,385), after controlling for patient demographics, socioeconomics, and comorbidities, hospital factors associated with feeding tube placement included stroke volume (odds ratio [OR] 1.28 highest vs lowest quartile; 95% confidence interval [CI] 1.10-1.49), for-profit status (OR 1.13 vs nonprofit; 95% CI 1.01-1.25), and intubation use (OR 1.66 highest vslowest quartile; 95% CI 1.47-1.87). In addition, hospitals with higher rates of black/Hispanic stroke admissions had increased risk of feeding tube placement (OR 1.28 highest vs lowest quartile; 95% CI 1.14-1.44). Conclusions: Variation in feeding tube insertion rates across hospitals is large. Differences across hospitals may be partly explained by external factors beyond the patient-centered decision to insert a feeding tube.

Original languageEnglish (US)
Pages (from-to)874-882
Number of pages9
JournalNeurology
Volume83
Issue number10
StatePublished - Sep 1 2014

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Enteral Nutrition
Inpatients
Stroke
Odds Ratio
Confidence Intervals
Hispanic Americans
Intubation
Stroke Volume
Observational Studies
Comorbidity
Length of Stay
Hospitalization
Retrospective Studies
Demography

ASJC Scopus subject areas

  • Clinical Neurology
  • Medicine(all)

Cite this

George, B. P., Kelly, A. G., Schneider, E. B., & Holloway, R. G. (2014). Current practices in feeding tube placement for US acute ischemic stroke inpatients. Neurology, 83(10), 874-882.

Current practices in feeding tube placement for US acute ischemic stroke inpatients. / George, Benjamin P.; Kelly, Adam G.; Schneider, Eric B.; Holloway, Robert G.

In: Neurology, Vol. 83, No. 10, 01.09.2014, p. 874-882.

Research output: Contribution to journalArticle

George, BP, Kelly, AG, Schneider, EB & Holloway, RG 2014, 'Current practices in feeding tube placement for US acute ischemic stroke inpatients', Neurology, vol. 83, no. 10, pp. 874-882.
George BP, Kelly AG, Schneider EB, Holloway RG. Current practices in feeding tube placement for US acute ischemic stroke inpatients. Neurology. 2014 Sep 1;83(10):874-882.
George, Benjamin P. ; Kelly, Adam G. ; Schneider, Eric B. ; Holloway, Robert G. / Current practices in feeding tube placement for US acute ischemic stroke inpatients. In: Neurology. 2014 ; Vol. 83, No. 10. pp. 874-882.
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abstract = "Objective: We sought to identify current US hospital practices for feeding tube placement in ischemic stroke. Methods: In a retrospective observational study, we examined the frequency of feeding tube placement among hospitals in the Nationwide Inpatient Sample with ≥30 adult ischemic stroke admissions annually with length of stay greater than 3 days. We examined trends from 2004 to 2011 and predictors using data from more recent years (2008-2011). We used multilevel multivariable regression models accounting for a hospital random effect, adjusted for patient-level and hospital-level factors to predict feeding tube placement. Results: Feeding tube insertion rates did not change from 2004 to 2011 (8.1 vs 8.4 per 100 admissions; p trend = 0.11). Among 1,540 hospitals with 164,408 stroke hospitalizations from 2008 to 2011, a feeding tube was placed 8.8{\%} of the time (n = 14,480). Variation in the rate of feeding tube placement was high, from 0{\%} to 26{\%} between hospitals (interquartile range 4.8{\%}-11.2{\%}). In the subset with available race/ethnicity data (n = 88,385), after controlling for patient demographics, socioeconomics, and comorbidities, hospital factors associated with feeding tube placement included stroke volume (odds ratio [OR] 1.28 highest vs lowest quartile; 95{\%} confidence interval [CI] 1.10-1.49), for-profit status (OR 1.13 vs nonprofit; 95{\%} CI 1.01-1.25), and intubation use (OR 1.66 highest vslowest quartile; 95{\%} CI 1.47-1.87). In addition, hospitals with higher rates of black/Hispanic stroke admissions had increased risk of feeding tube placement (OR 1.28 highest vs lowest quartile; 95{\%} CI 1.14-1.44). Conclusions: Variation in feeding tube insertion rates across hospitals is large. Differences across hospitals may be partly explained by external factors beyond the patient-centered decision to insert a feeding tube.",
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AB - Objective: We sought to identify current US hospital practices for feeding tube placement in ischemic stroke. Methods: In a retrospective observational study, we examined the frequency of feeding tube placement among hospitals in the Nationwide Inpatient Sample with ≥30 adult ischemic stroke admissions annually with length of stay greater than 3 days. We examined trends from 2004 to 2011 and predictors using data from more recent years (2008-2011). We used multilevel multivariable regression models accounting for a hospital random effect, adjusted for patient-level and hospital-level factors to predict feeding tube placement. Results: Feeding tube insertion rates did not change from 2004 to 2011 (8.1 vs 8.4 per 100 admissions; p trend = 0.11). Among 1,540 hospitals with 164,408 stroke hospitalizations from 2008 to 2011, a feeding tube was placed 8.8% of the time (n = 14,480). Variation in the rate of feeding tube placement was high, from 0% to 26% between hospitals (interquartile range 4.8%-11.2%). In the subset with available race/ethnicity data (n = 88,385), after controlling for patient demographics, socioeconomics, and comorbidities, hospital factors associated with feeding tube placement included stroke volume (odds ratio [OR] 1.28 highest vs lowest quartile; 95% confidence interval [CI] 1.10-1.49), for-profit status (OR 1.13 vs nonprofit; 95% CI 1.01-1.25), and intubation use (OR 1.66 highest vslowest quartile; 95% CI 1.47-1.87). In addition, hospitals with higher rates of black/Hispanic stroke admissions had increased risk of feeding tube placement (OR 1.28 highest vs lowest quartile; 95% CI 1.14-1.44). Conclusions: Variation in feeding tube insertion rates across hospitals is large. Differences across hospitals may be partly explained by external factors beyond the patient-centered decision to insert a feeding tube.

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