title: Decreased hospital stay and significant cost savings after routine use of prophylactic gastrostomy for high-risk patients with head and neck cancer receiving chemoradiotherapy at a tertiary cancer institution.
abstract: BACKGROUND
  Evidence-based nutritional and swallowing guidelines were developed to identify patients at high risk of developing malnutrition during chemoradiation for head and neck cancer. These guidelines recommended a prophylactic gastrostomy and were actively implemented at our institution in January 2007. This study assesses the effect of this policy change on patient outcomes.
  
  
  METHODS
  This retrospective cohort study was carried out for the years before (2005) and after (2007) implementation of these guidelines.
  
  
  RESULTS
  In all, 165 patients were treated with radical chemoradiation for head and neck cancer at our institution in the years 2005 and 2007. Gastrostomy tube complications were low. Patients in 2007 had significantly fewer hospital admissions, unexpected admissions, and a shorter mean duration of hospital stay in comparison with those in 2005.
  
  
  CONCLUSIONS
  Prophylactic gastrostomy tubes in patients with high-risk head and neck cancer resulted in a significant decrease in hospital admissions and length of stay, and led to increased bed availability.
authors.affiliation: Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. brett_hughes@health.qld.gov.au
authors.forename: Brett G M
authors.initials: BG
authors.lastname: Hughes
authors.forename: Vikram K
authors.initials: VK
authors.lastname: Jain
authors.forename: Teresa
authors.initials: T
authors.lastname: Brown
authors.forename: Ann-Louise
authors.initials: AL
authors.lastname: Spurgin
authors.forename: Gemma
authors.initials: G
authors.lastname: Hartnett
authors.forename: Jacqui
authors.initials: J
authors.lastname: Keller
authors.forename: Lee
authors.initials: L
authors.lastname: Tripcony
authors.forename: Mark
authors.initials: M
authors.lastname: Appleyard
authors.forename: Robert
authors.initials: R
authors.lastname: Hodge
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D015331:Cohort Studies; D017046:Cost Savings / Q000706:statistics & numerical data*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D063128:Tertiary Health Care; D016896:Treatment Outcome; D055815:Young Adult