Feeding tube dependence and postoperative complications in older adults after head and neck cancer surgery: a retrospective cohort study

Elderly patients undergoing head and neck cancer (HNC) surgery represent a high-risk population due to age-related decline and multimorbidity, with increased vulnerability to complications. Dysphagia and nutritional compromise are common, adversely affecting recovery and outcomes. This study evaluated the incidence of postoperative dysphagia, enteral feeding requirements, and related complications in this population. We retrospectively analyzed 46 patients aged ≥ 70 years who underwent major head and neck cancer surgery between 2019 and 2024. Clinical characteristics, tumor stage, nutritional status, and postoperative outcomes were collected. Enteral feeding strategies, including nasogastric tube (NGT) and percutaneous endoscopic gastrostomy (PEG), were evaluated. Dysphagia was assessed clinically and operationalized by the requirement for enteral feeding. Outcomes included feeding route at hospital discharge and at 3- and 6-month follow-up, duration of enteral feeding dependence, and postoperative medical complications. Statistical analyses comprised descriptive statistics and chi-square testing, with logistic regression used to identify predictors of PEG dependence. Fourteen patients (30.4%) required PEG and 19 (41.3%) NGT, with conversion from NGT to PEG in 17.4% (n = 8). Of the 19 patients initially managed with a NGT, 8 (42.1%) subsequently required conversion to PEG, representing 17.4% of the total cohort. At discharge, 65.2% (n = 30) achieved full oral intake; PEG dependence persisted in 23.9% (n = 11) at 3 months and 17.4% (n = 8) at 6 months. Advanced T stage was the only significant oncologic predictor, associated with PEG placement (p < 0.001) and dependence at 3 (p = 0.001) and 6 months (p = 0.049). Regression confirmed advanced T stage increased odds of PEG placement (OR = 5.4) and long-term dependence (OR = 11.4), while reducing the likelihood of oral intake at discharge (OR = 0.15). Laboratory analyses showed significant postoperative changes: serum albumin declined (3.93 ± 0.50 to 3.59 ± 0.63 g/dL, p = 0.0002), hemoglobin decreased (12.64 ± 1.88 to 10.17 ± 1.86 g/dL, p < 0.0001), WBC rose (7.29 ± 2.82 to 9.07 ± 3.92 × 10⁹/L, p = 0.008), INR increased slightly (1.03 ± 0.09 to 1.08 ± 0.12, p = 0.018), and potassium decreased modestly (4.39 ± 0.49 to 4.20 ± 0.45 mmol/L, p = 0.016). Complications were frequent: electrolyte imbalances (22%), aspiration pneumonia (8.9%), delirium (8.7%), and wound complications (8.7%). Less common but clinically relevant were acute kidney injury (6.5%), venous thromboembolism (2.2%), and refeeding syndrome (2.2%). Advanced T stage was the strongest predictor of PEG dependence in elderly head and neck cancer patients. Early nutritional screening and proactive multidisciplinary care, including geriatric assessment, are critical to reduce dysphagia-related morbidity and improving recovery.