The association between gastrostomy tube placement, poor post-operative outcomes, and hospital re-admissions in head and neck cancer patients

Abstract

Objectives Investigate the relationship of G-tube placement timing on post-operative outcomes. Participants 908 patients underwent resection of head and neck upper aerodigestive tract tumors between 2007 and 2013. Patient charts were retrospectively screened for patient demographics, pre-operative nutrition variables, co-morbid conditions, Tumor-Node-Metastasis staging, surgical treatment type, and timing of G-tube placement. Exclusionary criteria included death within the first three months of the resection and resections performed solely for nodal disease. Main Outcomes Post-surgical outcomes, including wound and medical complications, hospital re-admissions, length of inpatient hospital stay (LOS), intensive care unit (ICU) time. Results 793 surgeries were included: 8% of patients had G-tubes pre-operatively and 25% had G-tubes placed post-operatively. Patients with G-tubes (pre-operative or post-operative) were more likely to have complications and prolonged hospital care as compared to those without G-tubes (p < 0.001). Patients with pre-operative G-tubes had shortened length of stay (p = 0.007), less weight loss (p = 0.03), and fewer wound care needs (p < 0.0001), when compared to those that received G-tubes post-operatively. Those with G-tubes placed post-operatively had worse outcomes in all categories, except pre-operative BMI. Conclusions Though having enteral access in the form of a G-tube at any point suggests a more high risk patient, having a G-tube placed in the pre-operative period may protect against poor post-operative outcomes. Post-operative outcomes can be predicted based on patient characteristics available to the physician in the pre-operative period.

Predictors of returns to the emergency department after head and neck surgery

“…Less than half of the patients (44.3%) who presented to the emergency department were admitted to the hospital. Our overall rate of 30dURs (4.7%) is less than similar studies, which documented readmission rates ranging from 7.3% to 15% in patients who had undergone head and neck surgery.…”

Early death among head and neck cancer patients

“…As PEG carries a certain mortality risk, a useful and less invasive alternative could be the use of a nasogastric tube. Mays et al [27] saw that patients receiving a gastrostomy tube preoperatively had a shorter length of stay, less weight loss, and fewer wound care needs, than patients receiving a postoperative gastrostomy tube.…”

Factors associated with gastrostomy tube dependence following salvage total laryngectomy with microvascular free tissue transfer

“…As patients and providers choose between surgical and nonsurgical paradigms for management of locally advanced larynx cancer, understanding treatment implications for long‐term swallowing function is critical. G‐tube dependence has been associated with increased postoperative complications, prolonged hospitalization, hospital readmission, and decreased quality‐of‐life in head and neck cancer patients …”