Comparing in-hospital outcomes between total parenteral nutrition and enteral feeding in esophageal and gastric cancer: A nationwide analysis.

Abstract

e16086 Background: Patients with gastric and esophageal cancer (GEC) may experience significant dysphagia resulting in malnutrition and weight loss. Nutritional support may be provided parenterally utilizing total parenteral nutrition (TPN) or enterally through gastrostomy or jejunostomy (G/J) tube placement. We sought to compare in-hospital outcomes between patients with GEC receiving TPN and those that underwent G/J tubes. Methods: The National Inpatient Sample (NIS, 2016-2020) was utilized for this study. All hospitalizations of adult patients with GEC associated with TPN or G/J tube placement were included in the study. Hospitalizations that included TPN and a G/J tube were excluded. Demographic and clinical data were analyzed using chi-squared test, independent sample t-test, and binary logistic regression (adjusted for age, gender, and Charlson comorbidity index or CCI). Adjusted Odds ratios (aOR) are presented with 95% Confidence intervals (CI). A p-value of less than 0.05 was considered statistically significant. Results: A total of 65,575 hospitalizations were included, of which,12,535 (19.1%) received TPN and 53,040 (80.9%) underwent G/J tube placement. Patients receiving TPN were younger (mean age 62.29 vs 65.86 years, p < .001), but had higher CCI (8.4 vs 7.4, p < 0.001). Nutrition consultation was notably higher among those receiving TPN (1.0% vs 0.8%, p = 0.009). On logistic regression analysis, hospitalizations with G/J tube placement had statistically significantly lower odds of mortality [aOR = 0.47 (95% CI 0.44-0.51)], DVT [aOR = 0.54 (95% CI O.48-0.61)], PE [aOR = 0.51 (95% CI 0.46-0.57)], acute liver failure [aOR = 0.66 (95% CI 0.51-0.84)], acute kidney injury [aOR = 0.64 (95% CI 0.60-0.67)], and sepsis [aOR = 0.46 (95% CI 0.43-0.49)]. Conclusions: These results underscore the favorable in-hospital outcomes linked to enteral feeding through G/J tube placement compared to TPN in patients with GEC. They provide additional evidence supporting G/J tube placement as the safer and preferred method of nutritional support for this population, while highlighting the inferior inpatient outcomes associated with TPN use. TPNN=12535 Gastrostomy/JejunostomyN=53040 p-value Age 62.29 ± 13.9 65.86 ± 11.2 <.001 Gender 4690 (37.4%) 13515 (25.5%) <.001 Race White 6720 (55.1%) 37545 (72.9%) <.001 Black 1775 (14.6%) 5700 (11.1%) CCI 8.4 ± 3.3 7.4 ± 3.4 <.001 Nutrition Consult 125 (1.0%) 405 (0.8%) .009 Length of stay 13.23 ± 11.89 11.19 ±10.41 <.001 Total Hospital Charges 158.2 ± 218.0 151.6 ± 192.0 .002 Mortality 1475 (11.8%) 2800 (5.3%) .47 (.44-.51) <.001 Sepsis 2560 (20.4%) 5255 (9.9%) .46 (.43-.49) <.001