1. Risk factors for gastrostomy tube dependence in transoral robotic surgery patients
- Author
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Swar Vimawala, Adam Luginbuhl, Ramez Philips, Joseph Curry, David Cognetti, and Michael C. Topf
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Oral Surgical Procedures ,Dependency, Psychological ,Logistic regression ,Enteral administration ,Robotic Surgical Procedures ,Risk Factors ,Chart review ,Transoral robotic surgery ,medicine ,Humans ,In patient ,Postoperative Period ,Intubation, Gastrointestinal ,Aged ,Neoplasm Staging ,Gastrostomy ,business.industry ,Squamous Cell Carcinoma of Head and Neck ,Middle Aged ,Surgery ,Oropharyngeal Neoplasms ,Increased risk ,Treatment Outcome ,Otorhinolaryngology ,Gastrostomy tube ,T-stage ,Female ,business ,Follow-Up Studies - Abstract
Objectives To determine the rate of gastrostomy tube dependence after transoral robotic surgery (TORS), and to determine which patient or surgical factors increase the likelihood of gastrostomy tube dependence. Methods Retrospective chart review of all patients who underwent TORS for oropharyngeal squamous cell carcinoma (OPSCC) at a single institution from January 2011 through July 2016. Patients who underwent TORS for recurrent OPSCC were excluded. Primary outcome was gastrostomy tube (g-tube) dependence. Univariable and multivariable logistic regression were performed to identify risk factors for g-tube dependence at 3-months and 1-year. Results A total of 231 patients underwent TORS during the study period. At 3-month follow-up, 58/226 patients (25.7%) required g-tube. At 1-year and 2-year follow-up, 8/203 (3.9%) and 5/176 (2.8%), remained dependent on g-tube, respectively. Advanced T stage (T3) (OR = 6.07; 95% CI, 1.28–28.9) and discharge from the hospital with enteral access (OR = 7.50; 95% CI, 1.37–41.1) were independently associated with increased risk of postoperative gastrostomy tube dependence at 1 year on multivariable analysis. Conclusions Long-term gastrostomy tube dependence following TORS is rare, particularly in patients that receive surgery alone. Patients with advanced T stage tumors have poorer functional outcomes. Early functional outcomes, as early as discharge from the hospital, are a strong predictor for long-term functional outcomes.
- Published
- 2021