Does a gastrostomy confer any benefits to either patients or their carers?

• Main Author: Kurien, Matthew
• Other Authors: Sanders, David ; Lennard, Lynne
• Published: University of Sheffield 2013
• Subjects: 610
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.605193

Introduction: A gastrostomy is an established means of providing enteral nutrition. Currently, uncertainty exists regarding the merits of this intervention particularly in certain patient subgroups. Aims: To determine if a gastrostomy confers any benefits to either patients or their carers. Methods: The first study assesses mortality in patients referred for a gastrostomy and the accuracy of the Sheffield Gastrostomy Scoring System (SGSS). Quality of life is then assessed in both gastrostomy patients and in carers using mixed methods, combining a health related quality of life questionnaire (EuroQol Group EQ-5DTM, a quantitative tool) and semi structured interviews (a qualitative tool). Factors influencing both these outcomes are then evaluated in two further studies, where variations in local practice and aftercare are assessed. Results: 1327 patients were referred for a gastrostomy between 2004-2010. Of these, 304 (23%) were declined this intervention following multidisciplinary team review. Mortality in this group was 35.5% at 30 days and 74.3% at 1 year. By comparison the mortality seen in the gastrostomy-inserted group at 30-days and 1-year respectively was 11.2% and 41.1% (p < 0.0001). Acceptable agreement was seen between predicted and actual mortality using SGSS (area under the receiver operating curve = 0.71). For quality of life (n=100), no significant change in mean EQ-5DTM index scores was noted in either patients (0.70 versus 0.71, p=0.83) or carers (0.95 versus 0.95, p=0.32) at baseline and 3 months post insertion. Variations in local practice particularly with regards to indications, timing of insertion, procedural volume and aftercare (dedicated community team reduced hospital readmissions from 23% to 2%, p=0.0001) may be contributing to some of the adverse outcomes identified following this intervention. Conclusions: The merits of gastrostomy feeding may be confined to certain patient groups. This body of work emphasizes the importance of appropriate patient selection and importance of appropriate counseling prior to gastrostomy.