Nasogastric vs. nasojejunal feeding in stroke patients under a DRG payment system: balancing clinical benefits and economic costs

BACKGROUND: Under the DRG payment system, the choice of enteral nutrition for stroke patients requires balancing clinical efficacy and economic costs. Nasogastric (NG) and nasojejunal (NJ) feeding are widely used, but comprehensive comparisons of nutritional outcomes, complications, and DRG‑related economic indicators remain limited. OBJECTIVE: To compare the clinical effects and economic burden of NG versus NJ enteral nutrition in stroke patients under DRG, and to provide evidence for individualized clinical decision‑making. METHODS: A retrospective study was conducted in stroke patients receiving enteral nutrition at a tertiary hospital in central China from January 2021 to December 2024. A total of 322 patients were initially enrolled (193 in NG group, 129 in NJ group), and 149 patients were eligible for final DRG economic analysis (83 in NG group, 66 in NJ group). To confirm model robustness, 1:1 propensity score matching (PSM) was performed (n = 66 pairs). Nutritional indicators, complications, length of stay, hospitalization costs, nutritional costs, and DRG cost overrun rates were compared. RESULTS: The NJ group had lower pretreatment hemoglobin, but showed significantly greater improvements in hemoglobin and albumin than the NG group (both P < 0.001). The incidence of malnutrition and inflammatory burden index were significantly lower in the NJ group (both P < 0.05). In DRG analysis, total hospitalization costs and nutritional costs were significantly higher in the NJ group (both P < 0.001), with a higher DRG overrun rate (77.3% vs. 62.7%, P = 0.055). Length of stay was similar between groups (P > 0.05). CONCLUSION: NJ is superior to NG in improving nutritional status and reducing malnutrition and inflammatory burden in stroke patients, but is associated with higher short‑term costs and greater DRG overrun risk. A risk‑stratified strategy is recommended under DRG to balance clinical benefits and economic sustainability.