Association between a 6-h feeding protocol and postprocedure hospital length of stay following percutaneous endoscopic gastrostomy in hospitalized adults: A before-and-after cohort study

Abstract

Background

Tolerance of enteral nutrition following percutaneous endoscopic gastrostomy is a barrier to discharge. This study investigated the impact of an expedited feeding protocol following percutaneous endoscopic gastrostomy on postprocedure length of stay (LOS).

Methods

We performed a before-and-after cohort study on hospitalized adults in whom percutaneous endoscopic gastrostomy was placed by surgeons following the implementation of a standardized feeding protocol in which enteral feeds were resumed at the preoperative rate 6 h later.

Results

Enteral feeding resumed within 6 h postoperatively in 93% of patients after protocol initiation. The mean ± SD time to the goal enteral rate after percutaneous endoscopic gastrostomy was significantly shorter following protocol implementation (15 ± 10 vs 50 ± 26 h, P ≤ 0.0001). Compared with the preprotocol cohort, there was no change in postoperative aspiration at 1 week (6% vs 4%, P = 0.531) or rates of tube dislodgement (10% vs 9%, P = 0.89), return to the operating room (10% vs 6%, P = 0.36), and surgical-site infection (9% vs 8%, P = 0.92) at 1 month in the protocol implementation cohort. On multivariable regression, an expedited feeding protocol generated a significantly shorter postprocedure LOS for patients remaining in the hospital for ≤1 week (β = −2.14, 95% CI, −2.98 to −1.30; P < 0.001).

Conclusion

An expedited feeding protocol following percutaneous endoscopic gastrostomy placement had a high degree of provider uptake without any significant change in safety outcomes. Beginning enteral nutrition within 6 h postoperatively at the preoperative rate reduced LOS by >2 days, suggesting that these protocols can address common delays to discharge.