Nutritional status and post-operative complications in patients undergoing surgery for advanced pharyngeal or laryngeal cancer

Abstract

Purpose Malnutrition is an important prognostic indicator of post-operative outcomes in patients undergoing surgery for head and neck cancer, however, limited studies utilize validated nutrition assessment tools to accurately assess risk. The aim of this study was to determine the relationship between nutritional status on post-operative complications and length of stay for patients undergoing either a laryngectomy, pharyngectomy or pharyngolaryngectomy for head and neck cancer. Methods Patients with head and neck cancer undergoing a laryngectomy, pharyngectomy or pharyngolaryngectomy at a tertiary hospital in Australia were eligible for this retrospective cohort study (n = 40). Nutritional status was assessed by the dietitian on admission using the validated Subjective Global Assessment tool. Clinical outcomes were collected via retrospective chart review and included length of stay and post-operative complications. Results Pre-operative malnutrition incidence was 40%. Malnourished patients had higher incidences of any type of complication (57% vs 44%, p = 0.013) and pressure injury (86% vs 14%, p = 0.011) compared to well-nourished patients. Well-nourished patients had a clinically important shorter median length of stay compared to malnourished patients (17.5 vs 20 days). Conclusion Early identification and management of malnutrition is essential to minimize risk of post-operative complications and reduce length of stay and should be considered a key component of prehabilitation programs.

Prehabilitation in Adults Undergoing Cancer Surgery: A Comprehensive Review on Rationale, Methodology, and Measures of Effectiveness

“…In a study of 637 patients, Zhang et al showed that up to 43.7% of patients could be identified as being at a high risk of malnutrition [38]. Furthermore, the presence of malnutrition is associated with a higher proportion of postoperative complications (81% vs. 42%, p = 0.013) in adults undergoing pharyngectomy or laryngectomy procedures [39]. In a meta-analysis of 22 studies (n = 9332), the risk of malnutrition ranged from 12.8% to 80.8%.…”

“…Studies on nutritional prehabilitation have used a variety of measurements to assess baseline nutritional status and identify cancer patients who are most at-risk of malnutrition. These incorporate objective nutrition parameters (anthropometric, biochemical, and immunological), subjective measurements (weight change and dietary intake change), and physical assessments (loss of muscle and fat mass) [39,[44][45][46]. It is important to note that, although they are separate conditions, sarcopenia and malnutrition often coexist [42].…”