National Trends in the Use of Percutaneous Endoscopic Gastrostomy (Peg) Tube Among Elderly Patients with Dementia in the Us from 2006-2011

Background:

Use of Percutaneous Endoscopic Gastrostomy (PEG) tubes among patients with dementia is controversial, with multiple studies showing no clear benefit in terms of risks of aspiration, survival or quality of life. Despite this growing evidence, studies analyzing the trends of use of PEG tube among demented patients are lacking. We aimed to use a national database to study the recent nationwide trends in the use of PEG tubes among patients with dementia. 

Methods:

We used the Nationwide Inpatient Sample (NIS) database to identify elderly patients (≥ 65 years) with dementia who underwent PEG tube placement from 2006-2011, using appropriate International Classification of Disease version 9-Clinical Modification (ICD-9 CM) codes. NIS is the largest publicly available all-payer inpatient care database in the US containing discharge level data from 5 to 8 million hospital stays per year. Annual rates of PEG tube placement were calculated for each year (2006-2011), fitted into a log-linear model and compared using Monte Carlo permutation test to study the changes in trend. Statistical analysis was done using STATA (v 13.0) and Joinpoint Regression Program (v 4.1.1).

Results:

A total of 489,413 elderly patients (≥ 65 years) with a diagnosis of dementia were identified during the study period, out of which 2720 patients underwent placement of PEG tube. The mean age was 81.62 (± 7,18), out of which 58%(n= 1561) were males and 55% (n=1266) were whites. The proportion of patients who underwent PEG tube placement decreased from 584 per 100,000 in 2006 to 449 per 100,000 in 2011 with an AAPC of -4.49%. Joinpoint analysis revealed that from 2009-2011, the proportion of elderly individuals with dementia getting PEG tube placement significantly declined from 602 per 100,000 to 449 per 100.000 with an AAPC of -13% (95% CI: 19.8% to -5.7%; p value <0.05). 

Conclusions:

Our study shows declining national trends in the placement of PEG tubes among hospitalized elderly individuals with dementia between 2006-2011. This trend may have resulted from, change in guidelines from various professional societies (American Geriatrics Society, Alzheimer’s association) discouraging the use of PEG tube among elderly patients as well as several high quality studies confirming the lack of benefit of feeding tubes among demented patients.