title: A model for predicting gastrostomy tube placement in patients undergoing surgery for upper aerodigestive tract lesions.
abstract: OBJECTIVE
  Identifying high-risk patients in the preoperative period can allow physicians to optimize nutritional status early for better outcomes after head and neck cancer resections.
  
  
  OBJECTIVE
  To develop a model to predict preoperatively the need for gastrostomy tube (G-tube) placement in patients undergoing surgery of the upper aerodigestive tract.
  
  
  METHODS
  This retrospective medical record review included all adult patients diagnosed with head and neck cancers who underwent tumor resection from 2007 through 2012 at Wake Forest Baptist Health, a level 1 tertiary care center. Records were screened for patient demographics, tumor characteristics, surgical treatment type, and postoperative placement of G-tube. A total of 743 patients underwent resection of head and neck tumors. Of these, 203 were excluded for prior G-tube placement, prior head and neck resection, G-tube placement for chemoradiotherapy, and resection for solely nodal disease, leaving 540 patients for analysis.
  
  
  METHODS
  Placement of postoperative G-tube.
  
  
  RESULTS
  Of the 540 included patients, 23% required G-tube placement. The following variables were significant and independent predictors of G-tube placement: preoperative irradiation (odds ratio [OR], 4.1; 95% CI, 2.4-6.9; P < .001), supracricoid laryngectomy (OR, 26.0; 95% CI, 4.9-142.9; P < .001), tracheostomy tube placement (OR, 2.6; 95% CI, 1.5-4.4; P < .001), clinical node stage N0 vs N2 (OR, 2.4; 95% CI, 1.4-4.2; P = .01), clinical node stage N1 vs N2 (OR, 1.6; 95% CI, 0.8-3.3; P = .01), preoperative weight loss (OR, 2.0; 95% CI, 1.2-3.2; P = .004), dysphagia (OR, 2.0; 95% CI, 1.2-3.2; P = .005), reconstruction type (OR, 1.9; 95% CI, 1.1-2.9; P = .02), and tumor stage (OR, 1.8; 95% CI, 1.1-2.9; P = .03). A predictive model was developed based on these variables. In the validation analysis, we found that the average predicted score for patients who received G-tubes was statistically different than the score for the patients who did not receive G-tubes (P = .01).
  
  
  CONCLUSIONS
  We present a validated and comprehensive model for preoperatively predicting the need for G-tube placement in patients undergoing surgery of the upper aerodigestive tract. Early enteral access in high-risk patients may prevent complications in postoperative healing and improve overall outcomes, including quality of life.
authors.affiliation: Department of Otolaryngology, Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Ashley C
authors.initials: AC
authors.lastname: Mays
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Farah
authors.initials: F
authors.lastname: Moustafa
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Mitch
authors.initials: M
authors.lastname: Worley
authors.affiliation: Department of Otolaryngology, Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Waltonen
authors.affiliation: Department of Biostatistical Sciences, Comprehensive Cancer Center, Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Ralph
authors.initials: R
authors.lastname: D'Agostino
mesh_terms: D000328:Adult; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D020380:Needs Assessment; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors