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 81105 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.