S1051 Higher Risks With Gastrostomy Tube Placement After Esophagectomy: Evidence From the National Inpatient Sample Database

Introduction: In advanced esophageal cancer, esophagectomy may be a part of the standard of care for treatment. This morbid surgery may lead to nutritional challenges, which often necessitate feeding tube placement. The efficacy and safety of gastrostomy vs jejunostomy tube approaches in this setting remain very limited. Methods: Adults with esophageal cancer who were hospitalized for esophagectomy were extracted via the National Inpatient Sample (2016-2022). Patients under 18 years or with pre-existing gastrostomy tubes were excluded. The use of enteral feeding methods during index hospitalization was assessed for clinical characteristics across 3 groups: gastrostomy, jejunostomy, and no feeding tube placement. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included sepsis, tube malfunction, acute kidney injury (AKI), critical care utilization, length of stay, and hospital charges. Results: Among 15,365 patients who underwent esophagectomy, 12.9% received jejunostomy tubes, and 3.1% received gastrostomy tubes. The mean age and Charlson Comorbidity Index scores between the 3 groups were comparable. All cohorts were predominantly men, White, and insured through Medicare. While a higher proportion of patients undergoing jejunostomy or gastrostomy tube placement were in the 51st-75th income quartile, a higher number among those without tube placement were 1 quartile lower (25th-50th). Palliative care use was highest in those undergoing gastrostomy tube placement. Gastrostomy tube placement was associated with significantly higher odds of complications as compared to those undergoing jejunostomy tube placement, including AKI, tube malfunction, sepsis, need for critical care, and all-cause mortality. The gastrostomy tube placement group had longer hospitalizations and incurred higher hospital charges. Conclusion: Compared to jejunostomy, gastrostomy tube placement was associated with significantly worse clinical outcomes and higher resource utilization. Given the rising incidence of esophageal cancer worldwide, it is imperative to optimize enteral access strategies to improve patient care. Future prospective studies are needed to validate these findings.