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American Head & Neck Society
Translational Research Meeting

April 21-22, 2015

AHNS Annual Meeting
April 22-23, 2015 during the
Combined Otolaryngology Spring Meetings


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The preoperative assessment and overall nutrition predicts postoperative complications and re-admissions in head and neck cancer patients

Presentation: S014
Topic: Outcomes
Type: COSM
Date: Wednesday, April 22, 2015
Session: 3:15 PM - 4:00 PM Scientific Session #3
Authors: Ashley C Mays, MD, Mitch Worley, BS, Feras Ackall, BS, Joshua Waltonen, MD, Ralph D'Agostino, Jr., PhD
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Institution(s): Wake Forest Baptist Health

Objectives: 1) Investigate the relationship between patient demographics, premorbid conditions, preoperative nutrition, and timing of gastrostomy tube (G-tube) placement on postoperative outcomes in head and neck cancer patients. 2) Determine a relationship between preoperative G-tube placement and postoperative complications


Methods: A retrospective chart review of all patients with head and neck cancers of the upper aerodigestive tract that underwent resection at Wake Forest Baptist Health from 2007-2013 was performed. Patient charts were screened for patient demographics, preoperative nutrition variables [ie, G-tube placement, body mass index (BMI)], co-morbid conditions, Tumor-Node-Metastasis (TNM) staging, surgical treatment type, and timing of G-tube or Dobhoff tube placement. Outcome measures were all post-surgical outcomes [wound and medical (non-wound) complications, hospital re-admissions], length of inpatient hospital stay (LOS), intensive care unit (ICU) time, and length of time requiring enteral access. Stepwise logistic and linear regression analysis was performed to identify the best compilation of the individual patient measures to predict the post-surgical outcomes of interest. Variables with a significance level of 0.10 or less were retained to allow for a comprehensive predictive model.


Results: 750 patients were included. When all complications were grouped to include all wound/non-wound complications and post-surgical hospital re-admissions (binary outcome 57% with complication), tobacco use (Odds Ratio [OR] 1.7, 95% Confidence Interval [95% CI] 1.1-2.6, p=0.009), pre-operative history of dysphagia (OR 1.6, 95% CI 1.1-2.3,  p=0.007), tumor (T-stage) (p<0.001, with stage 1 vs stage 4 OR 0.36 95% CI 0.23-0.58 and stage 3 vs stage 4 OR 1.71 95% CI 1.06-2.9), tracheotomy placement (OR 2.4, 95% CI 1.7-3.5, p<0.0001), and reconstruction type (OR 0.5, 95% CI 0.36-0.77, p=0.001) were found to be significant predictors of postoperative complications.


For predicting days in the ICU, 8 risk factors were retained: tobacco (p=0.005), age (p<0.001), heavy alcohol (p=0.03), reconstruction type (p<0.001), tracheotomy placement (p<0.001), T-stage (p<0.001), dysphagia (p=0.079), and preoperative weight loss (p=0.10) were found to be significant predictors, with a combined R2 value of the model of 17%, p<0.0001).  A similar model was found for predicting LOS, since ICU care time and LOS are strongly correlated (r=0.68, p<0.0001). Preliminary analysis also suggests that patients with G-tubes (pre-op or post-op) were more likely to have complications compared to those without G-tubes (p<0.001) but those with preoperative G tubes had a lower rate of complications compared to those with postoperative G-tubes (71.7% versus 76.0%).


Conclusions: Postoperative complications and prolonged hospital care can be predicted based on preoperative patient characteristics. Though G-tube placement at any point suggests a more high risk patient, using our published predictive model for G-tube placement in the preoperative period may protect against poor postoperative outcomes. 

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