Percutaneous Endoscopic Gastrostomy Tube Timing in Head and Neck Cancer Surgery.

Area of Science:

• Medical research
• Surgical oncology
• Gastroenterology

Background:

• Head and neck cancer (HNC) surgery often necessitates nutritional support via percutaneous endoscopic gastrostomy (PEG) tubes.
• The timing of PEG tube placement relative to HNC surgery may impact patient outcomes and healthcare resource utilization.

Purpose of the Study:

• To compare outcomes and complications in HNC patients receiving PEG tubes on the same day as surgery versus later in hospitalization.
• To identify potential differences in complication rates, length of stay, and hospital charges based on PEG tube timing.

Main Methods:

• Retrospective analysis of the Nationwide Inpatient Sample (2003-2014).
• Inclusion of patients undergoing ablative HNC procedures with PEG tube placement.
• Stratification into early (same-day) and late (later hospitalization) PEG groups.
• Comparison of demographics and outcomes using univariate and multivariate analyses.

Main Results:

• A total of 4,068 patients were analyzed; 54.23% received early PEG and 45.77% received late PEG.
• Late PEG placement was associated with higher rates of malnutrition and renal failure.
• Multivariate analysis revealed increased risks of aspiration pneumonia, pulmonary disease, sepsis, hematoma, wound disruption, surgical site infection, and fistula formation in the late PEG group.
• The late PEG group experienced significantly longer mean length of stay (17.1 vs. 12.6 days) and higher hospital charges ($159,993 vs. $125,705).

Conclusions:

• Same-day PEG tube placement in HNC patients is associated with reduced complication rates, shorter hospital stays, and lower costs.
• These findings suggest potential benefits of early, concurrent PEG tube insertion with HNC surgery.
• Further investigation is warranted to establish causality and optimize clinical practice guidelines.