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Outcomes following feeding gastrostomy (FG) insertion in patients with learning disability: a retrospective cohort study using the health improvement network (THIN) database
  1. Philip R Harvey1,
  2. Tom Thomas2,
  3. Joht Singh Chandan2,
  4. Neeraj Bhala2,
  5. Krishnarajah Nirantharakumar2,
  6. Nigel J Trudgill1
  1. 1 Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Birmingham, UK
  2. 2 Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Nigel J Trudgill; nigel.trudgill{at}


Objectives To measure the rates of lower respiratory tract infection (LRTI) and mortality following feeding gastrostomy (FG) placement in patients with learning disability (LD). Following this to compare these rates between those having LRTI prior to FG placement and those with no recent LRTI.

Design Retrospective cohort study.

Setting and participants The study population included patients with LD undergoing FG placement in the ‘The Health Improvement Network’ database. Patients with LRTI in the year prior (LYP) to their FG placement were compared with patients without a history of LRTI in the year prior (non-LYP) to FG placement. FG placement and LD were identified using Read codes previously developed by an expert panel.

Main outcome measures Incidence rate ratio (IRR) of developing LRTI and mortality following FG, comparing patients with LRTI in the year prior to FG placement to patients without a history of LRTI.

Results 214 patients with LD had a FG inserted including 743.4 person years follow-up. 53.7% were males and the median age was 27.6 (IQR 19.6 to 38.6) years. 27.1% were in the LYP patients. 18.7% had a LRTI in the year following FG, with an estimated incidence rate of 254 per 1000-person years. Over the study period the incidence rate of LRTI in LYP patients was 369 per 1000-person years, in non-LYP patients this was 91 per 1000-person years (adjusted IRR 4.21 (95% CI 2.68 to 6.63) p<0.001). 27.1% of patients died during study follow-up. Incidence rate of death was 80 and 45 per 1000-person year for LYP and non-LYP patients, respectively (adjusted IRR 1.80 (1.00 to 3.23) p=0.05).

Conclusion In LD patients, no clinically meaningful reduction in LRTI incidence was observed following FG placement. Mortality and LRTI were higher in patients with at least one LRTI in the year preceding FG placement, compared with those without a preceding LRTI.

  • nutritional support
  • respiratory infections
  • gastroenterology

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  • KN and NJT contributed equally.

  • Contributors PRH and NJT were responsible for the initial conception of the study. PRH, TT, JSC and KN then contributed to the data collection and analysis of the data. PRH, TT, JSC, NJT, NB and KN all contributed to the final version of the manuscript for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The full data set and statistical code for analysis can be requested from the corresponding author.

  • Patient consent for publication Not required.

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