Objective: We aimed to investigate the frequency and outcome of percutaneous endoscopic gastrostomy (PEG) tube implantation in patients with Parkinson’s disease (PD) during United States (US) hospitalizations.

Background: Dysphagia is a known complication of PD. PEG tube placement is a widely utilized therapy for select PD patients with dysphagia, but its frequency and outcome are underexplored. There are few published cohorts of patients with generalized neurologic illnesses and outcomes with PEG tubes.¹ To date, the largest study investigating PEG tube outcomes was in 83 parkinsonism patients.¹

Method: We performed a retrospective review of a de-identified and HIPAA-compliant US based database (Premier) of hospitalized PD patients encountered between 2018-2023. PEG tube implantation, patient discharge status (hospice, non-hospice, and expiration), and aspiration pneumonia diagnoses were analyzed. Descriptive statistics were reported.

Results: 501,159 encounters of hospitalized patients diagnosed with PD were reviewed. A total of 8,330 patients had PEG tubes placed, with a subset having repeated implantations for a total of 8,427 unique PEG tube placements. The proportion of patients who underwent PEG tube placement and later expired was 5.8% (n=483) compared to 4.4% (n=21,661) among those without PEG placement. The proportion of patients discharged to hospice was also higher among those with PEG placement at 8.97% (n=747) compared to 6.41% (n=31,587) among those without PEG placement. The difference in these proportions was statistically significant (X²=134.1, p<1E-5). Of patients who had a PEG tube placed, 40.5% (n=3,373) had a diagnosis of aspiration pneumonia with 904 (26.80%) of these diagnoses not present on admission. Comparatively, only 7.8% (n=38,662) of patients without PEG placement had diagnoses of aspiration pneumonia, of which 13.76% (n= 5,783) did not have this diagnosis on admission. This was a statistically significant difference (X²=12601.5, p<1E-6). Unfortunately, it is not clear for all cases whether aspiration preceded PEG placement.

Conclusion: This is the largest study of the frequency and outcome of PEG tube implantation in hospitalized PD patients. The rate of aspiration pneumonia was lower in patients with PEG implantation compared to those without placement of a PEG. However, more patients with PEG implantation were discharged to hospice or expired compared to those without placement of a PEG.

References: Brown L, Oswal M, Samra AD, Martin H, Burch N, Colby J, Lindahl A, Skelly R. Mortality and Institutionalization After Percutaneous Endoscopic Gastrostomy in Parkinson’s Disease and Related Conditions. Mov Disord Clin Pract. 2020 Jun 9;7(5):509-515. doi: 10.1002/mdc3.12971

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MDS Abstracts - https://www.mdsabstracts.org/abstract/frequency-and-outcome-of-peg-tube-implantations-in-hospitalized-parkinsons-disease-patients/