title: Predictive Factors for Preoperative Percutaneous Endoscopic Gastrostomy Placement: Novel Screening Tools for Head and Neck Reconstruction.
abstract: OBJECTIVE
  The treatment of head and neck cancer has varying impact on postoperative recovery and return of swallowing function. The authors aim to establish screening tools to assist in preoperatively determining the need for gastrostomy tube placement.
  
  
  METHODS
  The authors prospectively assessed all patients undergoing complex head and neck reconstructive surgery during a 1-year study period. Only patients tolerating an oral diet, without preoperative gastrostomies, were enrolled for study. Eight parameters were assessed including: body mass index (BMI), prealbumin, albumin, smoking history, comorbidities [including coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DM)], age, use of microvascular reconstruction, and type of defect. Two specific screening tools were assessed. In the first, a multivariate logistic regression model was employed to determine factor(s) that predict postoperative gastrostomy tube. In a second screening tool, the 8 parameters were scored between 0 to 1 points. The total score obtained for each patient was correlated with postoperative gastrostomy placement.
  
  
  RESULTS
  Out of the 60 study patients enrolled in the study, 24 patients (40%) received a postoperative gastrostomy. In the logistic regression model, albumin level was the only factor that was significantly associated with need for postoperative gastrostomy (P < 0.0023). A score of 4 or greater was determined to have a sensitivity of 83% and specificity of 61% for postoperative gastrostomy.
  
  
  CONCLUSIONS
  Patients with a score of 4 or more with this screening scoring system or those patients with an albumin level <3.5 g/dL were at high risk for postoperative feeding tube placement.
authors.affiliation: Division of Plastic and Reconstructive Surgery, North Shore-LIJ Health System, Hofstra University School of Medicine, New York, NY.
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Chandler
authors.forename: Denis
authors.initials: D
authors.lastname: Knobel
authors.forename: Munique
authors.initials: M
authors.lastname: Maia
authors.forename: Jason
authors.initials: J
authors.lastname: Weissler
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Smith
authors.forename: Raman R
authors.initials: RR
authors.lastname: Sharma
authors.forename: Katie E
authors.initials: KE
authors.lastname: Weichman
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Frank
authors.forename: Armen K
authors.initials: AK
authors.lastname: Kasabian
authors.forename: Neil
authors.initials: N
authors.lastname: Tanna
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003324:Coronary Artery Disease / Q000150:complications; D003679:Deglutition / Q000502:physiology; D048909:Diabetes Complications; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D005544:Forecasting; D005773:Gastroscopy / Q000379:methods*; D005774:Gastrostomy / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D011228:Prealbumin / Q000032:analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000032:analysis; D012907:Smoking
chemical_list: D011228:Prealbumin; D012709:Serum Albumin