Potential for health care cost savings with preoperative gastrostomy tube placement in the head and neck cancer population

Background: The purpose of this study was to examine the cost differences between preoperative and postoperative placement of gastrostomy tubes (G-tubes) in patients with head and neck cancer. Methods: We conducted a retrospective chart review of patients with aerodigestive tract cancers from 2010 to 2015. Data included inpatient and postdischarge costs, demographics, tumor characteristics, surgical treatment, length of stay (LOS), time spent in the intensive care unit (ICU), and readmissions. Results: Five hundred ninety patients were included in this study. There was a $7624 inpatient cost savings (P =.002) for those G-tubes placed preoperatively ($26 060) versus postoperatively ($33 754). Postdischarge costs did not differ significantly between groups (P =.60). There was a $9248 total costs savings (P =.009) for those patients with G-tubes placed preoperatively ($39 751) versus postoperatively ($48 999), despite patients with preoperative G-tubes having lower body mass index (BMI; P =.009), higher Association of Anesthesiologist (ASA) class (P =.02), more preoperative radiation (P <.001), and more free tissue transfer reconstruction (P =.007). Conclusion: There is potential for savings by placing G-tubes preoperatively, possibly driven by decreased LOS, despite data suggesting that patients with G-tubes placed preoperatively are higher risk.