Potential for health care cost savings with preoperative gastrostomy tube placement in the head and neck cancer population

Mays, Ashley C.; Bartels, Harrison G.; Wistermayer, Paul R.; Rohlfing, Matthew L.; Gentile, Christopher; D’Agostino, Ralph; Waltonen, Joshua D.

doi:10.1002/hed.24992

Cited by 7 publications

(9 citation statements)

References 20 publications

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“…In patients with laryngeal SCC, we found that higher quality care was not associated with late dysphagia but was associated with improved survival when dysphagia was present. [13][14][15] The majority of patients with OPSCC treated with radiation have a gastrostomy placed before or during treatment, despite a growing body of evidence that suggests that prophylactic gastrostomy placement is associated with worse long-term swallowing outcomes. These data suggest that dysphagia is common in laryngeal SCC, but its sequela is responsive to differences in quality of care, with progression to gastrostomy dependence less likely with higher quality care but survival unaffected by quality once gastrostomy dependence was present.…”

Section: Discussionmentioning

confidence: 99%

“…12 The addition of chemotherapy to radiation is associated with an increase in dysphagia as well as an increased use of prophylactic and therapeutic gastrostomy placement in an effort to reduce weight loss and treatment-related complications. [13][14][15] The majority of patients with OPSCC treated with radiation have a gastrostomy placed before or during treatment, despite a growing body of evidence that suggests that prophylactic gastrostomy placement is associated with worse long-term swallowing outcomes. [16][17][18][19][20][21][22][23][24] In addition to chemotherapy, there is a known relationship between radiation dose and the extent of short-term and longterm soft tissue toxicity, with doses >60 Gy associated with an increased risk of late dysphagia and gastrostomy use.…”

Section: Discussionmentioning

confidence: 99%

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Quality of care and short and long‐term outcomes of oropharyngeal cancer care in the elderly

et al. 2019

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Objective To examine associations between quality, short‐term and long‐term treatment‐related outcomes, and costs in elderly patients treated for oropharyngeal squamous cell cancer (OPSCC). Methods We retrospectively evaluated Surveillance, Epidemiology, and End Results (SEER)‐Medicare data from 666 patients diagnosed with OPSCC from 2004 to 2007 using multivariate regression and survival analysis. Quality indicators were derived from guidelines for recommended care and performance measures. Results Higher quality care was associated with lower risk of death in patients with dysphagia (hazard ratio [HR] = 0.44 [0.32‐0.60]), weight loss (HR = 0.42 [0.28‐0.62]), gastrostomy (HR = 0.47 [0.33‐0.68]), airway obstruction (HR = 0.41 [0.27‐0.62]), tracheostomy (HR = 0.17 [0.05‐0.67]), and pneumonia (HR = 0.53 [0.33‐0.85]). There were no significant differences in mean incremental costs associated with airway and swallowing impairment for patients receiving higher quality care. Conclusions Higher quality OPSCC care was associated with improved survival in elderly patients with airway and swallowing impairment. These data suggest that greater adherence to evidence‐based guidelines has favorable implications for long‐term outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Quality of care and short and long‐term outcomes of oropharyngeal cancer care in the elderly

et al. 2019

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“…Given the importance of swallowing to overall quality of life and the negative impact on quality of life of gastrostomy tube feedings, this information may play a role in patients’ decisions to proceed with surgery vs other forms of treatment 11,29 . Appropriately stratifying elderly patients at high risk for poor postoperative swallowing may allow for health care cost savings and decreased length of stay through preoperative gastrostomy tube placement 30 . In terms of longitudinal swallowing function, these data can be used to counsel elderly patients that most patients who achieve good swallowing function do so within 1 month of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…11,29 Appropriately stratifying elderly patients at high risk for poor postoperative swallowing may allow for health care cost savings and decreased length of stay through preoperative gastrostomy tube placement. 30 In terms of longitudinal swallowing function, these data can be used to counsel elderly patients that most patients who achieve good swallowing function do so within 1 month of surgery.…”

Section: Implications For Patient Carementioning

confidence: 99%

Swallowing Outcomes in Elderly Patients following Microvascular Reconstruction of the Head and Neck

Worley

Blair

Momin

et al. 2018

Otolaryngol.--head neck surg.

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Objective To describe swallowing outcomes in elderly patients undergoing microvascular reconstruction of the upper aerodigestive tract and identify risk factors for poor postoperative swallowing function. Study Design Case series with chart review. Setting Academic medical center. Subjects and Methods Sixty-six patients aged ≥70 years underwent microvascular reconstruction of the upper aero-digestive tract. The primary outcome measure was the Functional Oral Intake Scale (FOIS); preoperative and postoperative scores were dichotomized to define “good swallowing” and “poor swallowing.” Logistic regression was performed to identify risk factors for poor postoperative swallowing function. Results In total, 91% of reconstructions were performed for oncologic defects. The most common defect site was the oral cavity (67%), and the anterolateral thigh (29%) was the most frequently used donor site. At 3-year follow up, 75% of patients had good swallowing function with 95% of patients who achieved good swallowing function doing so within 6 months of surgery. On multivariable analysis, patients with pT4 tumors (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.0–25.6) and those undergoing at least partial glossectomy (OR, 4.7; 95% CI, 1.1–20.7) were more likely to experience poor swallowing function at 6-month follow-up. Conclusion Approximately half of elderly patients achieve good swallowing function within 6 months following microvascular reconstruction of the upper aerodigestive tract. Elderly patients with pT4 tumors and those requiring glossectomy are at highest risk for poor swallowing outcomes. These data can be used to inform preoperative patient counseling and design interventions aimed at improving swallowing function in those at high risk for poor outcomes.

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“…[21][22][23] A medical history including hypertension, a normal/underweight BMI, and depressive symptoms have been associated with increased risk for ED presentation. 17 With regard to peri-operative factors, prophylactic percutaneous gastronomy tube (PEG) placement has been associated with lower rates of hospital readmissions, 24,25 and airway management with tracheostomy has been associated with prolonged LOS. 26 Finally, in terms of post-operative factors, medical/surgical complications (e.g., pneumonia, wound infection, hemorrhage) have been associated with prolonged LOS and readmissions.…”

Section: Introductionmentioning

confidence: 99%

Associations between pre-, post-, and peri-operative variables and health resource use following surgery for head and neck cancer

et al. 2019

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Objective: We examined associations between pre-, post-, and peri-operative variables and health resource use in head and neck cancer patients.Methods: Patients (N=183) who were seen for a pre-surgical consult between January, 2012 and December, 2014 completed surveys that assessed medical history, a patient-reported outcome measure (PROM) of dysphagia, and quality of life (QOL). After surgery, peri-operative (e.g., tracheostomy, feeding tube) and post-operative (e.g., complications) variables were abstracted from patients' medical records.Results-Multivariate regression models using backward elimination showed that pre-surgical University of Washington Quality of Life (UW-QOL) Inventory and M.D. Anderson Dysphagia Inventory (MDADI) composite scores, documented surgical complications, and having a tracheostomy, were significant predictors of hospital length of stay, explaining 57% of the total variance (F(5,160) = 18.71, p< .001). Male gender, psychiatric history, and lower pre-surgical MDADI scores significantly predicted thirty-day unplanned readmissions (30dUR). Pre-surgical MDADI composite scores also significantly predicted ED visits within 30 days of hospital discharge (p=.02).

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Potential for health care cost savings with preoperative gastrostomy tube placement in the head and neck cancer population

Abstract: Background: The purpose of this study was to examine the cost differences between preoperative and postoperative placement of gastrostomy tubes (G-tubes) in patients with head and neck cancer.

Cited by 7 publications

References 20 publications

Quality of care and short and long‐term outcomes of oropharyngeal cancer care in the elderly

Quality of care and short and long‐term outcomes of oropharyngeal cancer care in the elderly

Swallowing Outcomes in Elderly Patients following Microvascular Reconstruction of the Head and Neck

Associations between pre-, post-, and peri-operative variables and health resource use following surgery for head and neck cancer

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