Researchers in Japan studied what happens when older hospital patients can’t tolerate feeding tubes—a common problem for people with acid reflux. When feeding tubes had to be stopped unexpectedly, hospitals lost money in two ways: they had to spend more on medical care that insurance wouldn’t cover, and they lost income from patient care services. The study found that about 1 in 4 patients experienced this problem, costing hospitals roughly $1,600 per 10 patients over a month. Understanding these costs could help hospitals prevent feeding tube problems and save money while keeping patients healthier.

The Quick Take

  • What they studied: How much money hospitals lose when feeding tubes stop working in older patients with acid reflux disease
  • Who participated: 149 older patients in a Japanese hospital’s long-term care ward who received feeding tubes between 2018 and 2021. About 35 of them (23.5%) had to stop using their feeding tubes because their bodies couldn’t tolerate them
  • Key finding: When feeding tubes were stopped due to intolerance, hospitals lost an average of about $15 per patient per day in unreimbursed medical costs, while also losing about $8 per day in other care revenue. Patients who were underweight (BMI below 17.4) caused even bigger losses
  • What it means for you: If you’re an older patient with acid reflux needing a feeding tube, hospitals may benefit from trying harder to prevent feeding tube problems through better nutrition planning and formula choices. This could mean better care for you and more sustainable hospital services. However, this study was done in Japan’s healthcare system, so results may differ in other countries

The Research Details

This was a retrospective observational study, meaning researchers looked back at patient records from 2018 to 2021 to see what actually happened, rather than conducting a new experiment. They collected information from 149 older patients in a Japanese hospital who received feeding tubes and tracked whether the tubes had to be stopped due to intolerance. The researchers then analyzed hospital billing records to calculate how much money was lost when feeding tubes were discontinued.

The study examined two types of hospital payment systems used in Japan: one where hospitals get paid for each service provided (like a restaurant bill), and another where hospitals get a fixed payment regardless of services (like a flat fee). This allowed researchers to see exactly where money was being lost. They also ran computer simulations to estimate what would happen with different numbers of patients and different patient characteristics.

Understanding the financial impact of feeding tube problems is important because it shows hospitals why preventing these problems is worth the investment. When hospitals know that feeding tube intolerance costs them money, they’re more likely to develop better prevention strategies. This approach—looking at both patient health and hospital finances—can lead to improvements that help both patients and healthcare systems.

This study has some strengths: it used real patient data from actual hospital records rather than relying on memory or surveys, and it examined a specific, measurable outcome (hospital costs). However, the study was conducted in only one Japanese hospital, so results may not apply everywhere. The study also couldn’t prove that feeding tube intolerance directly caused the financial losses—it only showed they happened together. Additionally, healthcare payment systems vary greatly between countries, so these specific dollar amounts may not apply outside Japan

What the Results Show

Among the 149 patients studied, 35 patients (23.5%) experienced feeding tube intolerance that led to stopping the feeding tube. These patients tended to weigh less and had their feeding tubes in place for shorter periods than patients who tolerated the tubes well.

When feeding tubes were stopped due to intolerance, hospitals faced two main financial problems. First, they had to spend more money on medical care that their payment system wouldn’t reimburse—an average of about $15 per patient per day one week after stopping the tube. Second, they lost income from patient care services (like room and board charges) at about $8 per patient per day.

The study identified two main risk factors for these financial losses: patients with feeding tube intolerance and patients who were underweight (BMI below 17.4). When the researchers ran simulations to predict what would happen across a typical group of 10 hospitalized older patients with acid reflux over 4 weeks, they estimated total losses of about $1,645. Patients who were underweight or receiving certain types of feeding formulas caused even greater losses.

The research found that the type of feeding formula used mattered—patients receiving polymeric formulas (standard nutrition formulas) had higher associated costs when intolerance occurred. The study also showed that the financial impact varied depending on patient weight, with underweight patients creating substantially larger financial burdens when feeding tube problems occurred. These findings suggest that hospitals might be able to reduce losses by carefully selecting feeding formulas and paying special attention to underweight patients

Previous research has documented that feeding tube intolerance is common in older patients with acid reflux and causes clinical problems like malnutrition and longer hospital stays. This study adds important new information by quantifying the financial impact, which hadn’t been clearly measured before. The findings support what healthcare experts have suspected—that preventing feeding tube problems is economically important, not just clinically important

This study looked at patients in only one Japanese hospital, so the results may not apply to other hospitals or countries with different healthcare systems. The payment system in Japan is unique, so the specific dollar amounts may not be relevant elsewhere. The study couldn’t prove that feeding tube intolerance directly caused the financial losses—it only showed they happened together. Additionally, the study couldn’t account for all factors that might affect costs, such as differences in how individual doctors managed patients or variations in hospital pricing

The Bottom Line

Based on this research, hospitals should consider investing in strategies to prevent feeding tube intolerance in older patients with acid reflux, such as: (1) careful selection of feeding formulas tailored to individual patients, (2) early nutritional assessment and intervention, and (3) special monitoring of underweight patients. These preventive approaches appear likely to reduce both patient suffering and hospital costs. However, these recommendations are based on one hospital’s experience in Japan, so hospitals in other settings should adapt them to their own circumstances. Confidence level: Moderate—the financial findings are clear, but the best prevention strategies need further research

Hospital administrators and healthcare finance teams should care about these findings because they show a clear financial incentive to prevent feeding tube problems. Doctors and nurses caring for older patients with acid reflux should care because preventing feeding tube intolerance could improve patient outcomes and reduce hospital burden. Patients and families should care because preventing these problems means better nutrition and shorter hospital stays. However, these findings are most directly applicable to hospitals in countries with similar payment systems to Japan’s. Patients in other healthcare systems may see different impacts

Hospitals that implement prevention strategies might see financial benefits within weeks to months as they reduce the number of feeding tube discontinuations. However, some benefits—like improved patient nutrition and shorter stays—may take longer to become apparent. Patients who receive better feeding tube management might notice improvements in their nutrition and energy levels within days to weeks

Want to Apply This Research?

  • Track daily tolerance of feeding tube nutrition by recording: (1) any stomach discomfort or reflux symptoms (0-10 scale), (2) amount of feeding tube nutrition received versus planned amount, and (3) any unplanned stops or changes to the feeding plan. This helps identify problems early
  • Work with your healthcare team to: (1) report any discomfort or reflux symptoms immediately rather than waiting, (2) keep a food and symptom diary if you’re transitioning off feeding tubes, and (3) follow recommended feeding schedules and formula types exactly as prescribed. These actions help prevent the problems this study identified
  • Long-term, track: (1) how long you’re able to maintain feeding tube nutrition without interruption, (2) your weight and nutritional status monthly, (3) frequency of reflux or stomach symptoms, and (4) any hospitalizations or feeding tube changes. Share this information with your healthcare team at each visit to catch problems early

This research describes financial impacts of feeding tube problems in a Japanese hospital setting and should not be interpreted as medical advice. If you or a loved one is using a feeding tube, discuss any concerns about tolerance, nutrition, or reflux symptoms with your doctor or healthcare team immediately. The financial findings from this study may not apply to hospitals outside Japan or to different healthcare payment systems. Treatment decisions should always be made in consultation with qualified healthcare professionals based on individual patient needs and circumstances. This summary is for educational purposes and does not replace professional medical guidance