• Benjamin P George, Adam G Kelly, Eric B Schneider, and Robert G Holloway.
• From the Department of Neurology (A.G.K., R.G.H.), the University of Rochester School of Medicine and Dentistry (B.P.G.), NY; and the Center for Surgical Trials and Outcomes Research, Department of Surgery (E.B.S.), Johns Hopkins University School of Medicine, Baltimore, MD.
• Neurology. 2014 Sep 2;83(10):874-82.

ObjectiveWe sought to identify current US hospital practices for feeding tube placement in ischemic stroke.MethodsIn a retrospective observational study, we examined the frequency of feeding tube placement among hospitals in the Nationwide Inpatient Sample with ≥30 adult ischemic stroke admissions annually with length of stay greater than 3 days. We examined trends from 2004 to 2011 and predictors using data from more recent years (2008-2011). We used multilevel multivariable regression models accounting for a hospital random effect, adjusted for patient-level and hospital-level factors to predict feeding tube placement.ResultsFeeding tube insertion rates did not change from 2004 to 2011 (8.1 vs 8.4 per 100 admissions; p trend = 0.11). Among 1,540 hospitals with 164,408 stroke hospitalizations from 2008 to 2011, a feeding tube was placed 8.8% of the time (n = 14,480). Variation in the rate of feeding tube placement was high, from 0% to 26% between hospitals (interquartile range 4.8%-11.2%). In the subset with available race/ethnicity data (n = 88,385), after controlling for patient demographics, socioeconomics, and comorbidities, hospital factors associated with feeding tube placement included stroke volume (odds ratio [OR] 1.28 highest vs lowest quartile; 95% confidence interval [CI] 1.10-1.49), for-profit status (OR 1.13 vs nonprofit; 95% CI 1.01-1.25), and intubation use (OR 1.66 highest vs lowest quartile; 95% CI 1.47-1.87). In addition, hospitals with higher rates of black/Hispanic stroke admissions had increased risk of feeding tube placement (OR 1.28 highest vs lowest quartile; 95% CI 1.14-1.44).ConclusionsVariation in feeding tube insertion rates across hospitals is large. Differences across hospitals may be partly explained by external factors beyond the patient-centered decision to insert a feeding tube.© 2014 American Academy of Neurology.

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