Use of percutaneous endoscopic gastrostomy feeding tubes and functional recovery in stroke rehabilitation: A case-matched controlled study

Objective: To compare the morbidity, mortality, and functional recovery of patients who require percutaneous endoscopic gastrostomy (PEG) placement for the management of dysphagia after stroke. Design: Retrospective case-matched controlled study. Setting: Acute stroke rehabilitation inpatient unit. Participants: Patients (N=193) who were admitted for stroke rehabilitation with a PEG tube in place from January 1, 1993, to December 31, 2002, were matched with 193 case controls without PEG. Patients and controls were within 90 days of stroke onset, and were matched for age, sex, type of stroke, FIM instrument score, duration from onset to stroke unit admission, and year of admission. Interventions: Not applicable. Main Outcome Measures: Length of rehabilitation hospital stay, improvement in FIM scores, FIM efficiency score, need for transfer back to acute care hospital, diagnosis for which transfer was required, final discharge destination, and survival status. Results: Significant differences were found between the 2 groups, PEG versus control, respectively, in the following variables: FIM efficiency (.42 +/- 57 vs .56 +/- .55, P=.016); need for transfer back to acute hospital (58/193 vs 23/193, P=.001); and survival status dead/alive (14/179 vs 3/190, P=.006). Nonsignificant differences were as follows: length of rehabilitation hospital stay (46.9 +/- 24.8d vs 43.3 +/- 19.7d, P= 11), improvement in total FIM score from admission to discharge (16.9 +/- 17.9 vs 21.0 +/- 15.5, P=.72), and final discharge destination home/institutional care (96/83 vs 101/89, P=.93). Pneumonia was the most frequent reason for transfer to acute care for patients with PEG. Conclusions: Patients who meet criteria for admission to a stroke rehabilitation unit and who have a PEG in place are at increased risk for medical complications and death. Those who survive, however, show similar functional recovery and rate of home discharge as case-matched controls. (c) 2005 by American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.