Trends in the Use of Feeding Tubes in North Carolina Hospitals: 1989 to 2000

Abstract

OBJECTIVE: National data describing the placement of feeding tubes demonstrated a rapid increase in use in the early and mid-1990s. In the past several years, substantial concerns have arisen regarding the appropriateness of the procedure in many chronically ill patients. The purpose of this study is to determine whether the use of feeding tubes has continued to increase through the 1990s despite these widely publicized concerns. DESIGN: Repeated measure cross-sectional study of the North Carolina Discharge Database. SETTING: Analyses of all nonfederal hospital inpatient admissions in North Carolina. MEASUREMENTS AND MAIN RESULTS: We examined the absolute numbers and rates of feeding tube placements from 1989 to 2000. The rate of feeding tube placement increased from 59/100,000 persons in 1989 to 94/100,000 persons in 2000, an overall 60% increase with slowing in the rate of increase in the late 1990s. However, when outpatient procedures were included, the increase in tube feeding continued throughout the 11-year period of observation. The increase was due to an increase in utilization within all hospitals over the time period. Utilization did not differ between profit and not for profit hospitals. The relative growth rate of inpatient feeding tube placement did not differ by age group but the absolute increase was greatest in those age 75 years and over. CONCLUSIONS: Our study demonstrates that the use of feeding tubes has continued to increase through the 1990s. This increase occurred despite ongoing controversy in the medical literature about feeding tube placement in chronically ill patients