Incidence of unplanned gastrostomy tube replacements and associated complications in people with motor neurone disease and other conditions: A retrospective audit of an Australian dietitian-led clinic.

BACKGROUND

Gastrostomy tube placement is a common intervention for long-term nutrition in people with dysphagia. Minimising complications such as tube dislodgement is integral in gastrostomy management, as unplanned replacements may require urgent care to prevent stoma closure. Anecdotally, people living with motor neurone disease (plwMND) have frequent complications, although the frequency compared to other conditions remains unknown. This single-centre retrospective audit aimed to quantify and compare gastrostomy-related complications between MND and other conditions.

METHODS

All adults managed with a gastrostomy from 2016 to 2021 attending a single centre, dietitian-led gastrostomy service were included. The service database and medical records were screened for complications including unplanned tube replacements, infection, hypergranulation tissue, compromised tube integrity or dislodgement and their frequency was compared in those with MND and in those with other conditions.

RESULTS

In total, n = 193 replacement gastrostomy tubes were required in n = 51 individuals. People living with MND had a statistically nonsignificantly lower rate and likelihood of first unplanned replacement compared to other conditions after adjustment for age (HR 0.42). Modelling demonstrated a reduced risk of unplanned replacement with a history of previous infection and hypergranulation tissue, and an increased risk with a history of compromised tube integrity and previous displacement in plwMND. Of unplanned replacements, 48% occurred between 90 to 180 days, with tube integrity the most frequently associated complication.

CONCLUSION

People living with MND were more likely to experience hypergranulation tissue but did not have a higher rate of unplanned tube replacements compared to those with other conditions. People experiencing higher rates of unplanned gastrostomy replacements may benefit from strategies to reduce complications.