The indications for surgical feeding tube (SFT) placement in trauma patients are poorly defined. Patient selection is critical as complications from SFTs have been reported in up to 70% of patients. A previous analysis by our group determined that 25% of the SFTs we placed were unnecessary and that older patients, patients with head and spinal cord injuries, and patients who needed a tracheostomy were more likely to require long term SFTs. Following this study, we modified our institutional guidelines for SFT placement. We hypothesized that a more selective placement strategy would result in fewer unnecessary SFTs.
A retrospective review of all adult patients from 2012-2016 with an ICU LOS>4 days and a SFT placed during admission was conducted. This group was compared to data collected prior to our change in practice (2007-2010). Data from 2011 was excluded as a washout period. "Necessary" SFT use was defined per established guidelines as either daily use of the SFT through discharge or for ≥28 days and "unnecessary" SFT use as all others.
257 SFTs were placed from 2007-2010 and 244 from 2012-2016. Following implementation of our selective SFT placement strategy, unnecessary SFT placement decreased from 25% in 2007-2010 to 8% in 2012-2016 (p<0.0001). Significant predictors of necessary SFT placement by univariate regression were: increasing age (OR 1.03/yr CI 1.01-1.04), head injury (OR 2.80 CI 1.71-4.60), cervical spinal cord injury (OR 4.42 CI 1.34-14.50), and need for tracheostomy (OR 1.41 CI 2.21-7.67). The overall complication rate was 11% (9% in the selective group vs. 13% in the pre-selective group, p=0.2574), and was highest following open SFT placement (22%).
A selective placement strategy for SFTs in our trauma population resulted in fewer unnecessary SFTs and a trend toward fewer complications. SFTs should be placed through a percutaneous approach whenever possible.
III STUDY TYPE: Therapeutic.
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