Predictive Factors for Preoperative Percutaneous Endoscopic Gastrostomy Placement

Abstract

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.

Predictors of Gastrostomy Tube Placement in Head and Neck Cancer Patients at a Rural Tertiary Care Hospital

“…Although low serum albumin has been associated with an increased risk of needing a G-tube, the utility of individual laboratory values in determining nutritional status is debated. 23 53 54 55…”

“…Prior studies are limited by small sample sizes and inclusion of patients undergoing only nonsurgical treatments, treatment of benign disease, small resections amenable to less extensive reconstructions, and/or patients delayed or secondary reconstructions, and heterogeneous analysis that limits statistical validity. 10,23,24 To better address this question, we conducted a retrospective review of the EMR at a large, rural, tertiary care hospital. All patients undergoing resection of head and neck cancers with immediate free-flap reconstruction were included, while those undergoing delayed or secondary reconstruction, only nonsurgical treatments, or those undergoing reconstruction with nonfree-flap techniques were excluded.…”

“…Although low serum albumin has been associated with an increased risk of needing a G-tube, the utility of individual laboratory values in determining nutritional status is debated. 23,[53][54][55] Lack of randomization, in terms of both G-tube placement and ablative and reconstructive surgeons, introduces selection bias in deciding which patients undergo surgical resection with free-flap reconstruction, as well as who undergoes G-tubes placement and at what time. To this end, we attempted to control for surgeons through hierarchical modeling to report associations independent of the ablative and reconstructive surgeons.…”

Gastrostomy in the era of minimally invasive head and neck cancer surgery

“…Specifically, for TORS, 26.7% of surveyed surgeons routinely do not place either nasogastric or gastrostomy feeding access, and only 2.2% of surgeons routinely place a PEG . Chandler et al outlines a preoperative scoring system to predict gastrostomy specific to head and neck reconstruction, with emphasis on low preoperative albumin as a major risk factor for postoperative complications . Mays et al found that perioperative GT with respect to head and neck tumor resection suggests a high‐risk patient with a complicated hospital stay, but also that preoperative GT can protect against poor postoperative outcomes such as prolonged hospital length of stay, wound complications, and weight loss .…”

“…7 Chandler et al outlines a preoperative scoring system to predict gastrostomy specific to head and neck reconstruction, with emphasis on low preoperative albumin as a major risk factor for postoperative complications. 20 Mays et al found that perioperative GT with respect to head and neck tumor resection suggests a high-risk patient with a complicated hospital stay, but also that preoperative GT can protect against poor postoperative outcomes such as prolonged hospital length of stay, wound complications, and weight loss. 21 Our data also suggests that postoperative outcomes can be improved by aggressive nutritional screening and early GT in appropriate candidates undergoing robotic primary head and neck tumor resection.…”