Percutaneous Endoscopic Gastrostomy Usage in Acute Ischemic Stroke: An Analysis of Trends in the United States From 2006 to 2022.

Abstract

Background and objectives: Data on how percutaneous endoscopic gastrostomy (PEG) utilization has changed over time in patients with acute ischemic stroke (AIS) in the United States are sparse. This study evaluates 17-year trends in PEG utilization in AIS hospitalizations in the United States.

Methods: The 2006-2022 National Inpatient Sample was used to conduct a serial cross-sectional study. International Classification of Diseases codes were used to identify primary AIS hospitalizations with and without PEG. We used joinpoint regression to compute the annualized percentage change (APC) in PEG usage over time and used multivariable regression to evaluate the association of IV thrombolysis (IV-tPA), mechanical thrombectomy (MT), and other hospitalization factors with odds of PEG use.

Results: Of 8,079,538 primary AIS admissions over the study period, the overall PEG prevalence was 3.9% but usage in the subset of AIS admissions undergoing MT was 11.0%. PEG utilization increased with age in both sexes (18-39-year-olds: men 2.7%; women 2.5%; 80 years or older: men 4.7% and women 4.6%). After multivariable adjustment, increasing Elixhauser comorbidity scores (OR 1.31, 95% CI 1.30-1.32) and MT utilization (OR 1.61, 95% CI 1.54-1.68) were associated with higher odds of PEG use while IV-tPA was associated with lower odds of utilization (OR 0.94, 95% CI 0.91-0.97) when compared with no treatment. PEG use declined by 2.9% annually across the study period (average APC 2.9%, 95% CI -3.2 to -2.5%), but the rate of decline was fastest in the period 2014-2018 (APC -7.4%, 95% CI -8.6 to -4.9), followed by 2006-2014 (APC -1.9%, 95% CI -2.5 to -0.9). Utilization did not change significantly in the period 2018-2022. The average time from admission to PEG placement was 9.3 days, and this increased progressively over time (p trend <0.001).

Discussion: PEG use in patients with AIS declined over the past decade. This decline is likely due to multifactorial reasons that warrant further studies, but changing clinical practice toward allowing for some more time for patients with AIS to recover from poststroke dysphagia may be one of the potential contributory factors.