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

• Patients that never require G-tubes have better outcomes and fewer re-admissions.
• Post-operative G-tube placement had worse outcomes than pre-operative placement.
• Length of stay, ICU time, and re-admissions were less with pre-operative placement.
• Weight loss, wound care needs, and complications were less with pre-operative placement.

ObjectivesInvestigate the relationship of G-tube placement timing on post-operative outcomes.Participants908 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 OutcomesPost-surgical outcomes, including wound and medical complications, hospital re-admissions, length of inpatient hospital stay (LOS), intensive care unit (ICU) time.Results793 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.ConclusionsThough 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.