(0313) Enteral Versus Parenteral Nutrition on Esophageal Cancer Patients' Outcomes: A Paradigm for Oncology Nutrition Optimization

Introduction: Individuals with esophageal cancer (EC) are at risk of malnutrition, attributed to gastrointestinal obstruction. Following therapeutic interventions and gastrointestinal reconstruction, the risk persists and may intensify. This study elucidates the impact of enteral vs parenteral nutrition outcomes for patients hospitalized with EC.

Methods: Adult EC-related discharges from 2019 and 2020 were analyzed via National Inpatient Sample data. Minors and mixed nutritional regimen discharges were excluded. Enteral and parenteral nutrition subgroups were identified using the International Classification of Diseases, 10th revision codes. The nutrition mode and outcomes were investigated using multivariable regression analyses determined through NIS dataset ICD-10 codes.

Results: Of 28,015 EC hospitalizations, 756 (2.7%) received enteral nutrition, and 1,064 (3.8%) received parenteral nutrition. After adjusting for confounding variables, parenteral independently predicted mortality (OR 1.75, p = 0.023). Enteral showed no higher mortality (OR 0.56, p = 0.162). Both increased stay length. Parenteral had significantly longer stays (+9.07 days, p < 0.001 vs 3.07 days, p = 0.001). Both had high hospitalization charges, however parenteral more significantly increased treatment cost (112,093 USD, p < 0.001 vs 54,953 USD, p = 0.01). Enteral had lower pneumonia odds compared to parenteral. Parenteral had higher complication odds, including esophageal perforation, constipation, diarrhea, acute kidney injury, ICU admission, and acute respiratory failure. Both increased the odds of malnutrition, fluid and electrolyte disorders and septic shock odds.

Conclusions: Our retrospective study highlights that parenteral and enteral nutrition increase hospitalization costs, stay length, and in-hospital adverse outcomes. Complications, including mortality, are more frequent with parenteral than enteral nutrition. Since EC patients face the highest risk of malnutrition and adverse effects, this work is imperative in counseling patients on artificial nutrition choices and outcomes, timeframes, and costs.