Predictors of emergent feeding tubes and tracheostomies in amyotrophic lateral sclerosis (ALS).
Predictors of emergent feeding tubes and tracheostomies in amyotrophic lateral sclerosis (ALS).
复制标题
DOI：
10.3109/17482968.2012.662987
复制
发表时间：
2012-05
期刊：
影响因子：
--
通讯作者：
Long JA
中科院分区：
文献类型：
--
作者：
Tsou AY;Karlawish J;McCluskey L;Xie SX;Long JA
Predictable decline in ALS makes unplanned gastrostomy and tracheotomy avoidable. We determined whether gastrostomy or tracheostomy insertion during emergent hospitalization is associated with patient or hospital characteristics, changed Medicare policy in 2001, or proximity to specialized ALS care. We performed a retrospective analysis of hospitalizations and procedures for ALS/MND patients in Pennsylvania between 1996–2009. We identified predictors of gastrotomy/tracheotomy during emergent hospitalization and trends over time. Patients underwent 1,748 gastrostomies and 373 tracheotomies. 32% of gastrostomies and 67% of tracheostomies were placed emergently. Emergent hospitalizations involving gastrostomy were more expensive with fewer home discharges. Blacks and Medicaid patients had higher odds of emergent gastrostomy placement. Conversely, academic hospital affiliation decreased odds of emergent gastrostomy or tracheostomy placement (AOR 0.49, AOR 0.37, p <0.001). After Medicare policy changes, gastrostomy use increased, while emergent gastrostomies decreased. Surprisingly, proximity to specialized care was associated with increased emergent gastrostomy placement. Blacks and Medicaid patients were more likely to undergo emergent gastrostomy insertion. Patients receiving gastrostomy during emergent admissions had fewer home discharges and higher costs. Academic hospital affiliation decreased odds of emergent gastrotomy or tracheotomy. After Medicare changes broadening access, while gastrostomy use increased, the proportion of emergent procedures decreased.
