title: The association between gastrostomy tube placement, poor post-operative outcomes, and hospital re-admissions in head and neck cancer patients.
abstract: OBJECTIVE
  Investigate the relationship of G-tube placement timing on post-operative outcomes.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors: Department of Otolaryngology, Watlington 4th Floor, Wake Forest Baptist Health, Medical Center Blvd, Winston Salem, NC, 27157, USA. Electronic address: ashleycmays@gmail.com.
authors: Ashley C
authors: AC
authors: Mays
authors: Wake Forest School of Medicine, Winston Salem, NC, USA. Electronic address: miworley@wakehealth.edu.
authors: Mitchell
authors: M
authors: Worley
authors: Wake Forest School of Medicine, Winston Salem, NC, USA. Electronic address: fackall@wakehealth.edu.
authors: Feras
authors: F
authors: Ackall
authors: Department of Biostatistical Sciences, Comprehensive Cancer Center, Wake Forest Baptist Health, Winston Salem, NC, USA. Electronic address: rdagosti@wakehealth.edu.
authors: Ralph
authors: R
authors: D'Agostino
authors: Department of Otolaryngology, Wake Forest Baptist Health, Winston Salem, NC, USA. Electronic address: jwaltone@wakehealth.edu.
authors: Joshua D
authors: JD
authors: Waltonen
mesh_terms: D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000295:instrumentation*; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies
keywords: Gastrostomy tube; Head and neck cancer; Outcomes; Risk assessment