Risk factors contributing to morbidity associated with feeding tubes placed for esophageal cancer patients undergoing esophagectomy: a single-center retrospective study
Bibliographic record
Abstract
Background: Perioperative nutritional optimization of patients undergoing esophagectomy for cancer is important as this population is prone to malnutrition associated with poor outcomes. Nutritional supplementation has been achieved via enteral nutrition through percutaneous feeding tubes such as gastrostomy (G-tubes) and surgical jejunostomy tubes (J-tubes). While they are often routinely placed for patients undergoing esophagectomy, these are associated with adverse events including infections, dislodgement, increased healthcare visits, among others. The morbidity associated with feeding tubes has not been well characterized. We aim to determine factors associated with adverse outcomes after feeding tube placement to guide appropriate use of feeding tubes in esophageal carcinoma patients. Methods: Patients who underwent esophagectomy for carcinoma and had at least one feeding tube placed from November, 2017 to October, 2021 at a single institution were retrospectively reviewed. Subgroup analyses were performed testing for relevant characteristics. Univariate and multivariate logistic regression analyses were conducted evaluating outcomes of interest. The primary outcome was the overall rate of tube-related complications. Results: A total of 144 patients were included with 212 feeding tubes placed (75 G-tubes; 137 J-tubes). The rate of any adverse event related to feeding tubes was 39%. Of these, 11% were wound infections, 16% required procedural intervention, 11% visited the emergency department (ED), and 2.5% required admission due to feeding tube-related complications. Factors independently associated with adverse events included smoking history [odds ratio (OR), 2.80; 95% confidence interval (CI): 1.34–6.23], being female (OR, 2.98; 95% CI: 1.36–6.72), induction treatment (OR, 2.65; 95% CI: 1.14–6.55), and J-tubes (OR, 2.07; 95% CI: 1.09–4.03). Laparoscopically placed J-tubes were associated with increased unplanned admissions compared to those placed via laparotomy (9.4% vs. 0%, P=0.01). Though not statistically significant, there was a trend toward more complications in those who were high risk for malnutrition [body mass index (BMI) <18 kg/m2, weight loss >10%] and comorbid (Charlson Comorbidity Index 5–6). Conclusions: There is significant morbidity related to feeding tubes. The risk profile of these tubes for individual patients should be carefully weighed against the nutritional benefits prior to placement. Patients should be carefully counselled on the possible adverse events and care requirements.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".