Otite Fadar Oliver, Nene Yash, Sabra Ahmed, Pfaff Lee, Anikpezie Nnabuchi, Akano Emmanuel Oladele, Patel Smit D, Burke Devin J, Wee Claribel D, Latorre Julius Gene Silva, Singla Amit, Morris Nicholas A, Mehndiratta Prachi, Khandelwal Priyank, Chaturvedi Seemant
Department of Neurology, State University of New York Upstate Medical University, Syracuse.
Department of Neurology, Rutgers New Jersey Medical School, Newark.
Neurol Clin Pract. 2025 Aug;15(4):e200495. doi: 10.1212/CPJ.0000000000200495. Epub 2025 Jun 26.
BACKGROUND AND OBJECTIVES: Data on how percutaneous endoscopic gastrostomy (PEG) utilization has changed over time in patients with acute ischemic stroke (AIS) in the United States are sparse. This study evaluates 17-year trends in PEG utilization in AIS hospitalizations in the United States. METHODS: The 2006-2022 National Inpatient Sample was used to conduct a serial cross-sectional study. International Classification of Diseases codes were used to identify primary AIS hospitalizations with and without PEG. We used joinpoint regression to compute the annualized percentage change (APC) in PEG usage over time and used multivariable regression to evaluate the association of IV thrombolysis (IV-tPA), mechanical thrombectomy (MT), and other hospitalization factors with odds of PEG use. RESULTS: Of 8,079,538 primary AIS admissions over the study period, the overall PEG prevalence was 3.9% but usage in the subset of AIS admissions undergoing MT was 11.0%. PEG utilization increased with age in both sexes (18-39-year-olds: men 2.7%; women 2.5%; 80 years or older: men 4.7% and women 4.6%). After multivariable adjustment, increasing Elixhauser comorbidity scores (OR 1.31, 95% CI 1.30-1.32) and MT utilization (OR 1.61, 95% CI 1.54-1.68) were associated with higher odds of PEG use while IV-tPA was associated with lower odds of utilization (OR 0.94, 95% CI 0.91-0.97) when compared with no treatment. PEG use declined by 2.9% annually across the study period (average APC 2.9%, 95% CI -3.2 to -2.5%), but the rate of decline was fastest in the period 2014-2018 (APC -7.4%, 95% CI -8.6 to -4.9), followed by 2006-2014 (APC -1.9%, 95% CI -2.5 to -0.9). Utilization did not change significantly in the period 2018-2022. The average time from admission to PEG placement was 9.3 days, and this increased progressively over time ( trend <0.001). DISCUSSION: PEG use in patients with AIS declined over the past decade. This decline is likely due to multifactorial reasons that warrant further studies, but changing clinical practice toward allowing for some more time for patients with AIS to recover from poststroke dysphagia may be one of the potential contributory factors.
背景与目的：关于美国急性缺血性卒中（AIS）患者经皮内镜下胃造口术（PEG）的使用情况随时间如何变化的数据较为匮乏。本研究评估了美国AIS住院患者中PEG使用情况的17年趋势。 方法：使用2006 - 2022年全国住院患者样本进行系列横断面研究。利用国际疾病分类代码识别有和没有进行PEG的原发性AIS住院病例。我们采用连接点回归计算PEG使用随时间的年化百分比变化（APC），并使用多变量回归评估静脉溶栓（IV - tPA）、机械取栓（MT）及其他住院因素与PEG使用几率的关联。 结果：在研究期间的8079538例原发性AIS入院病例中，PEG的总体使用率为3.9%，但在接受MT的AIS入院病例子集中使用率为11.0%。男女PEG使用率均随年龄增加而上升（18 - 39岁：男性2.7%；女性2.5%；80岁及以上：男性4.7%，女性4.6%）。多变量调整后，与未接受治疗相比，Elixhauser合并症评分增加（比值比1.31，95%置信区间1.30 - 1.32）和MT使用（比值比1.61，95%置信区间1.54 - 1.68）与PEG使用几率较高相关，而IV - tPA与较低的使用几率相关（比值比0.94，95%置信区间0.91 - 0.97）。在整个研究期间，PEG使用每年下降2.9%（平均APC 2.9%，95%置信区间 - 3.2至 - 2.5%），但在2014 - 2018年下降速度最快（APC - 7.4%，95%置信区间 - 8.6至 - 4.9），其次是2006 - 2014年（APC - 1.9%，95%置信区间 - 2.5至 - 0.9）。2018 - 2022年使用率无显著变化。从入院到放置PEG的平均时间为9.3天，且随时间逐渐增加（趋势<0.001）。 讨论：过去十年中，AIS患者的PEG使用有所下降。这种下降可能是多因素导致的，值得进一步研究，但临床实践的改变，即允许AIS患者有更多时间从卒中后吞咽困难中恢复，可能是潜在的促成因素之一。
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