Timing of gastrostomy tube placement and outcomes in stroke patients: a systematic review and meta-analysis of early versus deferred placement.

BACKGROUND: Gastrostomy tube placement provides long-term enteral access for stroke patients with persistent dysphagia, but the optimal timing of gastrostomy tube placement remains uncertain. Early gastrostomy tube placement may facilitate rehabilitation and discharge, but concerns remain about the necessity of the procedure in patients who may recover swallowing function. METHODS: We conducted a systematic review of studies that evaluated the timing of gastrostomy tube placement in patients with stroke. Early placement was defined as gastrostomy tube placement within 7 days of the qualifying stroke event or admission. Random-effects meta-analysis was used to pool binary outcomes as risk ratios (RRs), and hospital length of stay was pooled as a mean difference (MD). The primary analysis was restricted to studies using a ≤7-day cutoff, with a sensitivity analysis that incorporated one study using a ≤14-day cutoff. RESULTS: Four studies (245,553 patients) using a ≤7-day definition were analyzed, with one additional study (≤14-day definition) included as a sensitivity analysis. Early gastrostomy tube placement was associated with significantly shorter hospital length of stay (4 studies; MD, -11.38 days; 95% CI, -15.56 to -7.20; p < 0.001; I2 = 99.9%). Early placement was also associated with a significantly lower risk of venous thromboembolism (3 studies; RR, 0.47; 95% CI, 0.32-0.69; p < 0.001; I2 = 97.3%). No significant differences were observed for mortality (4 studies; RR, 1.08; 95% CI, 0.61-1.94; p = 0.78; I2 = 99.6%), pneumonia (2 studies; RR, 0.55; 95% CI, 0.23-1.31; p = 0.17; I2 = 83.2%), or discharge to a destination other than home (3 studies; RR, 0.97; 95% CI, 0.89-1.06; p = 0.53; I2 = 99.5%). A sensitivity analysis incorporating the ≤14-day study did not materially change the length-of-stay or mortality estimates. CONCLUSIONS: Early gastrostomy tube placement after stroke was associated with shorter hospitalization and lower risk of venous thromboembolism, without a clear effect on mortality, pneumonia, or discharge disposition.