Survival outcomes in gastrostomy fed stroke patients

Introduction Dysphagia following acute stroke is common. It is associated with increased morbidity and mortality and longer hospital length of stay. There is little evidence on survival outcomes in these patients.

Method Retrospective observational study looking at 153 consecutive patients with acute stroke who underwent gastrostomy insertion. Survival was assessed using Kaplan Meier survival curves. Associations between survival and age, sex and timing of gastrostomy insertion were analysed using log-rank. Multivariate analysis was performed with Cox regression proportional hazards.

Results At 2 years 21/153 (13.7%) patients were alive. Median survival in patients 80 or less was 270 days compared to 98 days in the over 80s (log-rank p-value <0.0001). Median survival for women was 158 days compared to 97 days in men (log-rank p-value: 0.014). There was no association between timing of gastrostomy insertion and survival (median survival for insertion within 28 days 158 days vs 139 days for insertion after 28 days p-value 0.997). On multivariable analysis, increasing age (as a continuous variable) and male gender were independently associated with a worse prognosis (HR 1.07 and 1.63 respectively).

Conclusion 2 year survival in these patients is poor. Advancing age and male sex are associated with a worse prognosis whereas timing of gastrostomy insertion is not related to outcome. This data supports findings from previous studies, which fail to show an advantage of early gastrostomy feeding. This study is important as it allows clinicians to provide patients and relatives with realistic information for future outcomes to allow informed decisions with regards to gastrostomy feeding.