Factors and outcomes associated with early and deferred gastrostomy tube placement in acute ischemic stroke patients in the United States

BACKGROUND: The appropriate timing of gastrostomy tube placement in patients with acute ischemic stroke who have dysphagia remains unclear. OBJECTIVE: To identify factors and outcomes associated with the early and deferred gastrostomy tube placement in patients with ischemic stroke after hospitalization in the United States. METHODS: We analyzed all acute ischemic stroke patients who underwent gastrostomy tube placement using data from the Nationwide Inpatient Sample (2016-2022). Early gastrostomy was identified if gastrostomy tube placement was performed within 7 days of admission. We performed logistic regression analysis to identify the effect of timing of gastrostomy (early versus deferred) on none to minimal disability, length of stay, and hospitalization cost after adjusting for variables that were significantly different in univariate analysis. RESULTS: Of 174,000 acute ischemic stroke patients who underwent gastrostomy tube placement during hospitalization, 57,475 (33.0%) underwent early gastrostomy tube placement. Patients who underwent early gastrostomy were significantly more likely to be older, white, women, and admitted to non-teaching hospitals. Patients who received mechanical thrombectomy were significantly less likely to undergo early gastrostomy tube placement. The proportions of patients who developed acute myocardial infarction (5.6% vs 11.9%), pulmonary embolism (1.9% vs 4.5%), urinary tract infection (21.3% vs 26.3%), sepsis (12.1% vs 29.8%), pneumonia (11.4% vs 30.3%), or deep venous thrombosis (5.2% vs 13.3%) were lower in patients who underwent early gastrostomy tube placement. Early gastrostomy was associated with both shorter length of stay (-9.46 days, 95% CI: -9.95 to -8.97, p < 0.001) and hospitalization cost (-$26,944, 95% CI: -28,604 to -252,284, p < 0.001) in the multivariate analyses. CONCLUSION: Early gastrostomy tube placement is associated with both a reduction in hospital costs and length of stay and lower rates of in-hospital adverse events.