Gastrostomy placement and mortality among hospitalized Medicare beneficiaries

Context.-Although the use of feeding tubes among older individuals stirs considerable controversy, population-based descriptive data regarding patient outcomes are scarce. Objective.-To describe hospitalized Medicare beneficiaries having gastrostomies placed and their associated mortality rates. Design.-Retrospective cohort study. Setting and Patients.-Hospitalized Medicare beneficiaries aged 65 years or older discharged in 1991 following gastrostomy placement (excluding individuals in health maintenance organizations). Main Outcome Measures.-Mortality at 30 days, 1 year, and 3 years following gastrostomy and characteristics of individuals undergoing gastrostomy placement. Results.-In 1991, claims reflecting gastrostomy insertion were submitted for 81 105 older Medicare beneficiaries following hospital discharge. The in-hospital mortality rate was 15.3%. Cerebrovascular disease, neoplasms, fluid and electrolyte disorders, and aspiration pneumonia were the most common primary diagnoses, The overall mortality rate at 30 days was 23.9% (95% confidence interval [CI], 23.65%-24.2%), reaching 63.0% (95% CI, 62.7%-63.4%) at 1 year and 81.3% (95% CI, 81.0%-81.5%) by 3 years. One in 131 white and 1 in 58 black Medicare beneficiaries aged 85 years or older was discharged alive or deceased from a hospital in 1991 following gastrostomy placement. Conclusions.-Gastrostomies are frequently placed in older individuals and more often in blacks; mortality rates following placement are substantial.