Gastrostomy Placement and Mortality Among Hospitalized Medicare Beneficiaries

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Abstract
APPROPRIATE NUTRITION is fundamental to curative medical care. Poor outcomes accompany malnutrition in a variety of clinical settings.1,2 Consequently, physicians and other caregivers may consider enteral feeding appropriate not only for patients who are unable to swallow, but also when oral intake is inadequate, sometimes irrespective of the ability to eat. Whereas permanent feeding tube placement previously necessitated major surgery, the percutaneous endoscopic gastrostomy3 introduced in the early 1980s requires only sedation for insertion. Among older persons, a possible consequence of both attitudes toward nutritional support and the introduction of the percutaneous endoscopic gastrostomy has been a substantial increase in gastrostomy placement among hospitalized patients. For example, between 1988 and 1995, the number of gastrostomies placed in hospitalized patients aged 65 years or older in the United States increased from approximately 610004 to 121000.5