Association between gastrostomy and clinical outcomes including septicemia, weight loss, mortality, and discharge dispositions among metastatic head and neck cancer patients hospitalized for treatment in the US.

Abstract

e18033 Background: The insertion of a gastrostomy tube provides nutritional support to a large number of patients diagnosed with head and neck cancer (HNC). However, gastrostomy tubes are not risk-free, and we hypothesized that they are linked to certain adverse outcomes such as healthcare associated complications (HACs). The purpose of this study was to identify these associations by analyzing data from 2019 hospitalizations of metastatic HNC patients in the US. Methods: Analysis was conducted utilizing the 2019 National Inpatient Sample Database. We utilized generalized linear models to determine the association between gastrostomy status and clinical outcomes – septicemia, weight loss, fluid and electrolyte abnormalities (FEA), mortality, and discharge dispositions, while adjusting for patient and clinical characteristics. Results: Among 21,565 hospitalized metastatic HNC patients,3,705 had undergone gastrostomy (G-HNC). In the adjusted analysis, gastrostomy was significantly associated with mortality (aOR 1.46, 95%CI: 1.04-2.06), septicemia (aOR 1.61, 95%CI: 1.27-2.05), FEA (aOR 1.37, 95%CI: 1.11-1.67), and weight loss (aOR 2.11, 95%CI: 1.75-2.55). Additionally, G-HNC patients were more likely to be referred to skilled nursing facilities (aOR 1.50, 95%CI: 1.19-2.02) and home health care services (HHC) (aOR 1.41, 95%CI: 1.16-1.72), than home without services. Among G-HNC patients, African Americans were more often referred to HHC than home, when compared to whites (aOR 1.34, 95%CI: 1.01-1.79). Compared to males, females more commonly developed FEA (aOR 1.36, 95%CI: 1.15-1.60). Conclusions: Gastrostomy was linked to worse clinical outcomes in this study. G-HNC patients had greater rates of septicemia, weight loss, and FEA, which may increase mortality. Our ongoing efforts involve evaluating the trajectory of these outcomes in the US, and making sure that these patients receive advanced care to reduce HACs while hospitalized.