title: Does feeding tube insertion and its timing improve survival?
abstract: OBJECTIVE
  To examine survival with and without a percutaneous endoscopic gastrostomy (PEG) feeding tube using rigorous methods to account for selection bias and to examine whether the timing of feeding tube insertion affected survival.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  All U.S. nursing homes (NHs).
  
  
  METHODS
  Thirty-six thousand four hundred ninety-two NH residents with advanced cognitive impairment from dementia and new problems eating studied between 1999 and 2007.
  
  
  METHODS
  Survival after development of the need for eating assistance and feeding tube insertion.
  
  
  RESULTS
  Of the 36,492 NH residents (88.4% white, mean age 84.9, 87.4% with one feeding tube risk factor), 1,957 (5.4%) had a feeding tube inserted within 1 year of developing eating problems. After multivariate analysis correcting for selection bias with propensity score weights, no difference was found in survival between the two groups (adjusted hazard ratio (AHR) = 1.03, 95% confidence interval (CI) = 0.94-1.13). In residents who were tube-fed, the timing of PEG tube insertion relative to the onset of eating problems was not associated with survival after feeding tube insertion (AHR = 1.01, 95% CI = 0.86-1.20, persons with a PEG tube inserted within 1 month of developing an eating problem versus later (4 months) insertion).
  
  
  CONCLUSIONS
  Neither insertion of PEG tubes nor timing of insertion affect survival.
authors.affiliation: Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, Providence, RI 02912, USA. Joan_Teno@brown.edu
authors.forename: Joan M
authors.initials: JM
authors.lastname: Teno
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Gozalo
authors.forename: Susan L
authors.initials: SL
authors.lastname: Mitchell
authors.forename: Sylvia
authors.initials: S
authors.lastname: Kuo
authors.forename: Ramona L
authors.initials: RL
authors.lastname: Rhodes
authors.forename: Julie P W
authors.initials: JP
authors.lastname: Bynum
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000401:mortality*; D008297:Male; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors