Nasal feeding tubes tied to fewer adverse events than feeding via ostomy

Surgical feeding ostomies (eg gastrostomy) result in significantly higher in-hospital adverse event rates than natural orifice (eg, nasogastric or orogastric) feeding tubes, a study has shown. Thus, policies that require surgical feeding ostomies must be re-evaluated.

In this prospective, observational, cohort study, the investigators analysed enterally fed inpatients using semiweekly focused physical examination, scripted survey, and chart review.

All tube-fed patients were admitted to a large, urban, academic hospital and received semiweekly bedside assessment and chart review over a 9-week period (n=226 unique patients; mean, 6.25 visits each; total 1,118 observations). Demographics were similar between 148 patients with natural orifice and 113 with surgical feeding tubes.

The incidence of adverse events was higher with surgical feeding tubes (3.34 vs 1.25 events per 100 patient days; p<0.001). However, only half of all adverse events (50 percent) were documented in the medical records. In addition, more patients with surgical tubes were discharged to skilled nursing facilities (58 percent vs 24 percent).

“These results suggest that surgical feeding ostomies may be a higher-risk intervention than natural orifice feeding tubes in the hospital setting,” the investigators said. “Clinicians and administrators should consider these results in patient care and discharge and admission policy decisions.”

Nursing home policies requiring surgical feeding ostomies could endanger patients for serious and underdocumented compilations, especially when the prognosis for recovery of full oral nourishment is short-term or indeterminate. [Cochrane Database Syst Rev 2015;CD008096]

“Future research should examine strategies to compare the safety of natural orifice feeding tubes and surgical feeding ostomies in a more controlled manner including surgical feeding ostomy reversal rates and to further incorporate outpatient experiences,” the investigators said.

“In the absence of strong evidence for superiority of surgical feeding ostomies, skilled nursing facilities should place more emphasis on patient prognosis, patient autonomy, and risk-to-benefit in their admission policies,” they added.