Author(s)
Kyle P. Davis, BS
Leah J. Novinger, MD
Alexander J. Jones, MD
Kendall M. Burgett, BS
Andrea Bonetto, PhD
Avinash V. Mantravadi, MD
Michael W. Sim, MD
Micheal G. Moore, MD
Affiliation(s)
Indiana University School of Medicine; Department of Otolaryngology - Head and Neck Surgery; Department of Surgery;
Abstract:
Objective: Determine the impact of preoperative cachexia on postoperative outcomes in patients with head and neck cancer undergoing resection and free flap reconstruction.
Study Design: Single institution, retrospective cohort
Methods: Consecutive, adult patients from 01/01/2015-11/01/2019 undergoing head and neck cancer resection with free tissue reconstruction were included. Patients with metastatic or concurrent primary malignancy were excluded. Patients were stratified by the presence or absence of preoperative cachexia. Preoperative, intraoperative, and postoperative variables were collected. Univariate and multivariate analyses were conducted to determine patients’ and perioperative variables’ impact on postoperative complications.
Results: Out of 267 total patients, 140 (52.4%) had preoperative cachexia. The cachectic group was older (62.0 vs. 58.4 years, p=0.031) with lower BMI (23.9 vs. 27.6 kg/m2, p<0.0001) and greater incidence of PVD (16.4% vs. 6.3%, p=0.012). The cachexia group had higher proportions of squamous cell carcinomas (89.3% vs. 70.1%, p<0.001) and aerodigestive tumors (76.3% vs. 63.8%, p=0.032). Postoperatively, cachectic patients more often acquired sepsis (7.1% vs. 1.6%, p=0.037), unplanned reintubation (18.6% vs. 2.4%, p=0.033), and discharge to a rehabilitation facility (31.4% vs. 25.6%, p=0.009). The cachexia group had an elevated rates of serious ACS-NSQIP complications (41.4% vs. 22.0%, p=0.001) and flap-specific complications (47.1% vs. 31.5%, p=0.012). After multivariate regression, cachexia remained a significant predictor of incurring a serious ACS-NSQIP complication (p=0.015, OR [95% CI] = 2.03 [1.15-3.59]).
Conclusion: Preoperative cachexia was associated with increased postoperative complications in head and neck cancer free flap reconstruction patients.