Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, 634-8521, Kashihara, Nara, Japan.
Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, 351-0197, Wako-shi, Saitama, Japan.
BMC Geriatr. 2021 Jan 28;21(1):80. doi: 10.1186/s12877-020-02003-x.
Enteral feeding and parenteral nutrition (PN) using gastrostomy (GS) and a nasogastric tube feeding (NGT) and PN should be initiated for older patients based on their prognoses. This study aimed to investigate the long-term prognosis of patients aged ≥75 years who underwent enteral feeding via GS and NGT as well as PN.
A population-based cohort study was conducted using Japan's universal health insurance claims in the Nara Prefecture. This study enrolled 3,548 patients aged ≥75 years who received GS (N=770), NGT (N=2,370), and PN (N=408) during hospital admissions between April 2014 and March 2016. The GS group was further categorized into secondary GS (N=400) with preceding NGT or PN within 365 days and primary GS (N=370) without preceding NGT or PN groups. In the secondary GS group, 356 (96%) patients received NGT (versus PN). The outcome was mortality within 730 days after receiving GS, NGT, and PN. Cox regression analyses in cases with or without malignant diseases, adjusted for sex, age, comorbidity, and hospital type, were performed to compare mortality in the groups.
Of the 3,548 participants, 2,384 (67%) died within 730 days after the initiation of GS and NGT and PN. The 2-year mortality rates in the secondary GS, primary GS, NGT, and PN groups were 58%, 66%, 68%, and 83% in patients without malignancies and 67%, 71%, 74%, and 87% in those with malignancies, respectively. In the non-malignant group, Cox regression analysis revealed that secondary GS (hazard ratio (HR) = 0.43, 95% CI: 0.34-0.54), primary GS (HR = 0.51, 95% CI: 0.40-0.64), and NGT (HR = 0.71, 95% CI: 0.58-0.87) were statistically significantly associated with lower mortality compared with PN.
Approximately 58% to 87% patients aged ≥75 years died within 730 days after initiation of nutrition through GS, NGT, or PN. Patients with non-malignant diseases who received secondary GS exhibited better 2-year prognosis than those who received NGT or PN. Healthcare professionals should be aware of the effectiveness and limitations of enteral feeding and PN when considering their initiation.
对于老年患者，应根据其预后情况，通过胃造口术（GS）和鼻胃管喂养（NGT）以及肠外营养（PN）开始肠内喂养。本研究旨在调查≥75 岁接受 GS 和 NGT 以及 PN 肠内喂养的患者的长期预后。
本研究采用日本奈良县全民健康保险索赔数据进行基于人群的队列研究。本研究纳入了 2014 年 4 月至 2016 年 3 月期间住院期间接受 GS（N=770）、NGT（N=2370）和 PN（N=408）的≥75 岁患者 3548 例。GS 组进一步分为二级 GS（N=400），即在 365 天内有过先前的 NGT 或 PN，以及原发性 GS（N=370），没有先前的 NGT 或 PN。在二级 GS 组中，有 356 名（96%）患者接受了 NGT（而非 PN）。结局是接受 GS、NGT 和 PN 后 730 天内的死亡率。对有无恶性肿瘤的病例进行 Cox 回归分析，调整性别、年龄、合并症和医院类型，比较各组的死亡率。
在 3548 名参与者中，有 2384 名（67%）在接受 GS 和 NGT 以及 PN 后 730 天内死亡。无恶性肿瘤患者中，二级 GS、原发性 GS、NGT 和 PN 组的 2 年死亡率分别为 58%、66%、68%和 83%，有恶性肿瘤患者的 2 年死亡率分别为 67%、71%、74%和 87%。在非恶性肿瘤组中，Cox 回归分析显示，二级 GS（风险比（HR）=0.43，95%置信区间：0.34-0.54）、原发性 GS（HR=0.51，95%置信区间：0.40-0.64）和 NGT（HR=0.71，95%置信区间：0.58-0.87）与 PN 相比，死亡率显著降低。
大约 58%至 87%的≥75 岁患者在开始通过 GS、NGT 或 PN 进行营养支持后的 730 天内死亡。患有非恶性疾病的患者接受二级 GS 治疗的 2 年预后优于接受 NGT 或 PN 治疗的患者。医护人员在考虑开始肠内喂养和 PN 时，应了解其有效性和局限性。
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