Survival after percutaneous endoscopic gastrostomy among older residents of Quebec

CONTEXT: Percutaneous endoscopic gastrostomy has become a mainstay of nutri tional support for individuals with swallowing dysfunction. There is little population-based data to guide the use of this intervention in older indiv iduals. OBJECTIVE: To describe the use of percutaneous endoscopic gastrostomy among older residents of Quebec and to evaluate patient characteristics associat ed with subsequent survival and hospital discharge. DESIGN: A population-based cohort study. SETTING: Quebec, Canada. PATIENTS: 175 individuals with a billing claim for percutaneous endoscopic gastrostomy performed in 1993. MEASUREMENTS: Billing and hospitalization databases were used to collect pa tient characteristics, medical diagnoses, discharge destinations, and dates of death. The relationships between demographic and diagnostic variables b efore gastrostomy, and subsequent survival and discharge home, were evaluat ed using survival analysis. RESULTS: Median survival after gastrostomy was 210 days. Mortality at 30 da ys was 18.3%. Decreased survival was associated with a previous diagnosis o f malignancy (risk ratio (RR) = 1.71; 95% CI, 1.09 -2.68); mortality did no t increase with increasing age. Of 163 individuals hospitalized at the time of gastrostomy, 42 (26%) were discharged home. Individuals with a previous diagnosis of stroke (RR = 2.80; 95% CI 1.01-7.77) were more likely to be d ischarged home than other individuals. CONCLUSIONS: Survival after percutaneous endoscopic gastrostomy is poor; th e requirement for such a procedure appears to be a marker for severe underl ying disease. The greater likelihood of return home after gastrostomy among individuals with stroke suggests that the use of this intervention as an a djunct to rehabilitation is appropriate in these individuals.