Ashley C Mays1, Mitchell Worley2, Feras Ackall3, Ralph D'Agostino4, Joshua D Waltonen5. 1. Department of Otolaryngology, Watlington 4th Floor, Wake Forest Baptist Health, Medical Center Blvd, Winston Salem, NC, 27157, USA. Electronic address: ashleycmays@gmail.com. 2. Wake Forest School of Medicine, Winston Salem, NC, USA. Electronic address: miworley@wakehealth.edu. 3. Wake Forest School of Medicine, Winston Salem, NC, USA. Electronic address: fackall@wakehealth.edu. 4. Department of Biostatistical Sciences, Comprehensive Cancer Center, Wake Forest Baptist Health, Winston Salem, NC, USA. Electronic address: rdagosti@wakehealth.edu. 5. Department of Otolaryngology, Wake Forest Baptist Health, Winston Salem, NC, USA. Electronic address: jwaltone@wakehealth.edu.
Abstract
OBJECTIVES: Investigate the relationship of G-tube placement timing on post-operative outcomes. PARTICIPANTS: 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. MAIN OUTCOMES: 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.
OBJECTIVES: Investigate the relationship of G-tube placement timing on post-operative outcomes. PARTICIPANTS: 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. MAIN OUTCOMES: 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.
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