Reassessing the timing of percutaneous gastrostomy tube placement: Too many too soon

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tubes are used for patients requiring long-term feeding access but are often placed to facilitate hospital disposition. Given the associated procedural risks and potential for patient recovery, we aimed to investigate the rate of return to oral intake after PEG placement, procedural indications, and complications to better elucidate the risk-benefit balance of PEG placement. METHODS: We conducted a retrospective review of all patients who underwent nonelective PEG tube placement at our Level 1 trauma center from January 1, 2023, to March 1, 2024. Patient demographics, procedure details, time to resumption of oral intake, and outcome data were collected. Primary outcome was return to oral intake at discharge. Secondary outcomes included placement for disposition purposes and complication rate. Patients were followed for 1 year after discharge. RESULTS: Of 233 patients identified, 59.7% resumed oral intake by time of discharge, 18.7% of which had returned to normal feeding. The median time to discharge from PEG placement was 11 days (interquartile range, 3-30 days). Furthermore, 37.3% of PEGs were placed for hospital disposition. The overall complication rate was 24.5% (46% Clavien-Dindo grade 3 or higher). Patients who had a PEG placed for disposition resumed an oral diet at a median of 5.5 days versus 17.5 days in those not done for disposition ( p < 0.01). There were similar overall complication rates but a significantly higher proportion of Clavien-Dindo grade ≥3 complications ( p = 0.02) in the PEG placed for disposition group. Overall, 19.7% of PEGs were placed in patients who were nutritionally independent by discharge, experienced in-hospital mortality, or were discharged to hospice. CONCLUSION: Most patients who received a nonelective PEG resumed oral intake prior to discharge. Over one third of procedures were done to facilitate patient disposition, and nearly half of all complications required procedural intervention. Delaying PEG placement until closer to discharge may reduce unnecessary procedures and the associated complications. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.