Exploring outcomes of percutaneous endoscopic gastrostomy tubes following strokes, when the decision for insertion was made in a patient's best interest.

Abstract

Background: Percutaneous endoscopic gastrostomy (PEG) tube insertion decisions can be complex in incapacitated stroke patients, resulting in poor patient survival rates following the procedure. Aim: The aim of this study was to calculate the average length of survival of stroke patients with a PEG when a best interest decision (BID) was made, compared with when the patient consented (CS). Method: All PEGs inserted between 2020�2022 in an NHS Foundation Trust which serves 45 000 people in the West Midlands were identified through a review of electronic records. Collated data were analysed using SPSS software. Findings: Some 36 PEG procedures were performed in the study period, 16 CS and 20 BID (equalling 55.56% incapacitated stroke patients). CS patients had a mean survival of 271.3 days (P=0.001, standard deviation (SD) 138) and BID patients 245.8 days (P=0.001, SD 141.3), giving a 25.6-day difference. An effect size Cohen's d analysis with Hedges' correction for BID with lower correction was 0.98 (CI 95%), and for CS it was 1.04 (CI 95%). When using the upper interval data it was 2.33 BID (CI 95%) and for CS it was 2.66 (CI 95%). Conclusions: BID PEG tube insertions in incapacitated stroke patents demonstrated shorter survival times than in stroke patients able to consent to their PEG procedure.