Outcome in patients who require a gastrostomy after stroke

Dysphagia is common after a stroke and is associated with a poor outcome in terms of survival or functional recovery. Percutaneous gastrostomy (PG) provides reliable and safe nutrition for patients with neurological dysphagia in the short term but little is known about the the subsequent outcome in stroke patients. We reviewed the medical records of all stroke patients who had required a PG in four West Yorkshire hospitals over a 30-month period. All patients alive at the time of the study were contacted and functional status was recorded. Forty-one stroke patients had undergone PG and 37 records were obtained. There were 24 men and 13 women with a mean age of 74 years. Thirty-three patients had had a hemiplegia while four patients presented acutely with dysphagia but no hemiplegia (all had cerebral infarcts on CT scan). The timing of PG varied with a median time from stroke of 26 days (range 12-131). Complications include five chest infections ( < 1 week after PG), three local infections, two tubes pulled out and one perforation. Three patients died in the first 5 days after the PG. Thirty-one of the 37 patients had died at the time of the assessment, 21 during the original hospital admission. The median survival from the time of PG was 53 days (range 2-528) with only 12 patients surviving for more than 3 months. Six patients were alive at the time of the study and all but one were severely disabled (mean modified Barthel Index seven). There is no consensus about patients selection or timing of PG and our data should lead to more careful consideration of the risks and benefits of the procedure in stroke patients.