Objective: We sought to determine the incidence of feeding tube (FT) placement in Alzheimer’s disease (AD), Parkinson’s disease (PD), or amyotrophic lateral sclerosis(ALS) population, describe yearly trends from 1990 to 2009, and analyze its association with length of stay and discharge destination.

Background: Aspiration pneumonia is a leading cause of death in PD. Although FT has its proven value in ALS, the evidence does not support its use in AD, and is insufficient in PD. Furthermore, evidence shows that FT does not prevent aspiration with patients with dysphagia.

Method: Secondary analysis of a national database from 1990 to 2010 was conducted using International Classification of Diseases, 9th revision, Clinical Modification codes for PD, AD, and ALS, and procedure codes for PEG. Descriptive analysis was performed for all years using binomial regression model to determine the trend of PEG placement over the 21 years. The median length of stay and discharge destinations were compared.

Results: FT placement was, on average, 3.5% lower per year (P < .001) in PD, 6.7% lower per year (P < .001) in AD, and 0.3% lower per year (P = .007) in ALS. The median length of stay increased 3 to 6 days in all patients with FT placement. Odds of being discharged to a long-term or short-term facility more than doubled with FT (OR 2.7, 95% CI 2.6-2.7 in AD, and OR 4.8, CI 4.6-4.9 in PD). But it halved in ALS patients (OR 0.5, CI0.4-0.5).

Conclusion: Our results show that the rate of FT placement in ALS was unchanged, while the rates among PD and AD patients have declined. However, thousands of PD and AD patients still undergo FT placement each year despite limited evidence to support its use. Further research is necessary to understand the effects of FT on outcome, physician practices and patient expectations in advanced PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/long-term-yearly-trends-of-feeding-tube-placement-in-neurodegenerative-disorders/