Introduction: Dysphagia is common in acute neurologic disorders. An important decision in inpatient management is whether to place a surgical Percutaneous Endoscopic Gastrostomy (PEG). There is a lack of consensus on optimum timing of commitment to long-term enteral nutrition, and prediction of recovery is unreliable in the acute stage. However, most recovery occurs in the rehabilitation phase. This study evaluates feasibility and implementation of a pathway that supports discharging patients with small bore nasogastric feeding tubes (NGTs) to rehabilitation, deferring the decision for PEG until after the acute phase to allow for swallow recovery. Methods: Observational retrospective cohort study of neuroscience services discharges. The primary outcome is number of discharges with NGTs compared to neuroscience PEG surgical case volume. Adult patients admitted to Mass General Hospital or Brigham and Woman’s Hospital neuroscience services, discharged after 1/1/2022 with an NGT in place for dysphagia were included. Data was analyzed using R v4.4.2 (2024-10-31). Results: The sample included 274 patients discharged between 2022–2025, with 47.8% from BWH and 52.2% from MGH. Admission sources were interhospital transfers (48.5%), Emergency Department (34.7%), elective surgical (14.6%) and direct admissions (2.2%). Mean age was 65.5 years and mean length of stay was 12.5 days (SD=8.6). Common DRGs included craniotomy or complex CNS conditions (26.6%), intracranial hemorrhage/stroke (24.5%), and craniotomy/endovascular procedures (15.6%). Significant changes over time were observed in PEG placements and NGT discharges (p=0.0066), with NGT discharges increasing (slope=+16.5) and PEG placements decreasing (slope=–38.2). Conclusions: Overall, neuroscience inpatient PEG placements decreased following the pathway implementation, while NGT discharges increased in parallel. This indicates enrollment growth and feasibility of implementation of the pathway. This model has the potential to avoid premature inpatient PEG placement, reducing unnecessary procedures and associated surgical complications, and improving cost and efficiency.
Chakra et al. (Sun,) studied this question.