Data from: Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in older persons with dysphagia: A propensity-matched cohort study

Background: The long-term outcomes of artificial nutrition in older people
with dysphagia remain uncertain. Enteral nutrition via percutaneous
endoscopic gastrostomy (PEG) is one of the major methods of artificial
nutrition. Enteral feeding is indicated for patients with a functional
gastrointestinal tract. However, total parenteral nutrition (TPN) is often
inappropriately chosen for artificial nutrition in Japan, even in patients
with a functional gastrointestinal tract, as PEG has recently been viewed
as an unnecessary life-prolonging treatment in Japan. This study aimed to
compare the long-term outcomes between PEG and TPN. Methods: This
single-center retrospective cohort study investigated long-term outcomes
in older patients with dysphagia who received PEG or TPN between January
2014 and January 2017. The primary outcome was survival time. Secondary
outcomes were oral intake recovery, discharge to home, and the incidence
of severe pneumonia and sepsis. We performed 1-to-1 propensity score
matching using a 0.05 caliper. The Kaplan–Meier method, log-rank test, and
Cox regression analysis were used to compare the survival time between
groups. Results: We identified 253 patients who received PEG (n=180) or
TPN (n=73). Older patients, those with lower nutritional states, and
severe dementia were more likely to receive TPN. Propensity score matching
created 55 pairs. Survival time was significantly longer in the PEG group
(median, 317 vs 195 days; P=0.017). The hazard ratio for PEG relative to
TPN was 0.60 (95% confidence interval: 0.39–0.92; P=0.019). There were no
significant differences between the groups in oral intake recovery and
discharge to home. The incidence of severe pneumonia was significantly
higher in the PEG group (50.9% vs 25.5%, P=0.010), whereas sepsis was
significantly higher in the TPN group (10.9% vs 30.9%, P=0.018).
Conclusions: PEG was associated with a significantly longer survival time,
a higher incidence of severe pneumonia, and a lower incidence of sepsis
compared with TPN.