Nutritional assessment and post-procedural complications in older stroke patients after insertion of percutaneous endoscopic gastrostomy – a retrospective study

Abstract

BackgroundOropharyngeal dysphagia is one of the major complications of stroke and a risk factor for malnutrition and prolonged in-hospital stay.ObjectiveThe overall aim was to describe to what extent nutritional assessments (i.e. BMI kg/m2, eating problem, and weight loss) were performed and documented in the records of older stroke patients treated with enteral nutrition by percutaneous endoscopic gastrostomy (PEG). A secondary aim was to identify documented post-procedural complications after PEG insertion during hospital stay.DesignThe study is retrospective. Data were collected from records of 161 stroke patients ≥65 years, who received PEG, admitted to three stroke units during a 4-year period.ResultsMean age of the patients was 82.2 (±7) years, and 86% of the patients were ≥75 years old. On admission, body weight was documented in 50% of the patients and at discharge in 38% of the patients. BMI data were not documented at all at discharge in one of the units. Almost 80% of the patients fulfilled the European Network criteria for multimorbidity. Morbidity and multimorbidity correlated to the length of stay (p<0.0005). Complications were reported in 111 (69%) of the patient records. In 53 patients (33%) more than one complication was reported. A total of 116 pressure ulcers were reported and 30 patients had more than one pressure ulcer. The number of complications was related to weight loss (p=0.046) and BMI change (p=0.018).ConclusionsEssential information of the patient's nutritional status was poorly recorded which could affect the patient's nutritional treatment during the hospital stay. This study indicates that implementation of guidelines in patients with stroke is needed. The high number of pressure ulcers was an unexpected finding.

Nutritional Approach and Treatment in Patients with Stroke, An Expert Opinion for Turkey

“…At most, 50-75% of the targeted calorie should be administered to patients who have developed refeeding syndrome. It is important to prevent this fatal complication in patients at risk of developing refeeding syndrome by starting enteral nutrition at very small amounts, and gradually increasing the volume (118,124,125,126).…”

Enteral Nutrition: Indications, Applications, Type of Formula in Different Geriatric Diseases

“…Perkütan endoskopik gastrostomi sonrası komplikasyonların değerlendirildiği 116 yaşlı bireyde, ağırlık kaybı ve beden kitle indeksi değişimi komplikasyon sayısı ile pozitif yönde ilişkilendirilmiştir. 16 Üst gastrointestinal sistem veya mide enteral beslenme için kullanılamaz ise jejunostomi yoluyla jejunal beslenme alternatif yol olabilmektedir. 17 Karbonhidratlar, enteral nütrisyonda kullanılan ürünlerde enerjinin büyük kısmını sağlamaktadır.…”

Endoscopic gastrostomy for nutritional support in post-stroke dysphagia

“…Although most patients recover within the first four weeks, 15 % of patients may develop long-term swallowing difficulties (5,6). Dysphagia may contribute to poor nutritional status and, if not promptly recognized, may lead to dehydration and malnutrition (3,7,8). Furthermore, dysphagia is a major cause of aspiration pneumonia, which may be the leading cause of death in these patients (1,7).…”