Early Gastrostomy Versus Late Gastrostomy Tube Performed in ALS Patients Admitted with Aspiration Pneumonia in the United States
Baljinder Singh1, Yixin Chen 2, Xueying Liu2, Rajeev Motiwala1, MaryLynn Chu1, Harmandeep Brar3, Jacqueline Kraus4, Elina Zakin1
1NYU School of Medicine, 2Virginia Tech University, 3Shri Guru Ram Das Medical College, 4University of New Mexico
Objective:
Aspiration pneumonia is a common complication in patients with amyotrophic lateral sclerosis (ALS). Gastrostomy tube placement in these patients is favorable for nutrition however longer length of hospitalization could lead to increased financial burden on patient population in United States.
Background:
To compare the clinical outcome and in-hospital complication risk with early (defined as within one week of admission) versus late (defined as after one week of admission) gastrostomy tube placement among patients with ALS.
Design/Methods:
We obtained data for ALS patients admitted to hospitals in the United States from 2017 to 2019 with primary diagnosis of aspiration pneumonia using large national database. We determined the rate and pattern of utilization of associated in-hospital outcomes of gastrostomy tube placement in this patient population.
Results:
A total of 934 patients underwent gastrostomy tube out of which 548 (58.7%) had early gastrostomy and 386 (41.3%) had late gastrostomy tube placement. The racial differences in white, black, Hispanics, and others in early versus late gastrostomy tubes were: (73.9% vs. 63.5%, p<0.001), (8.5% versus 16.6%, p< 0.100), (8.2% vs. 11.9%, p>0.05), (9.5% vs 8.03% p>0.05) resp. No racial differences were observed in Hispanic population and other populations, however white population received early gastrostomy more than the black population. Patients who underwent late gastrostomy tube placement had more in-hospital complications including, sepsis (43.2% vs. 34.3%, p<0.01), and deep vein thrombosis (6.3% vs. 2.3%, p < 0.01). A significant difference was noticed between academic versus non-academic medical centers. Teaching hospitals performed early gastrostomies 1.4 times more than non-teaching hospitals (p<0.001). Length of stay during hospitalization was significantly lower in the early gastrostomy tube versus late gastrostomy tube groups (3.7% vs. 16.4%, p<0.01).
Conclusions:
The length of stay, and thus the cost of hospitalization is less in ALS patients who were admitted with aspiration pneumonia and were offered early gastrostomy tube.