Preoperative prognostic nutritional index as a method to predict postoperative complications after major head and neck surgery with free tissue transfer reconstruction

Abstract

Background Head and neck (H&N) cancer patients are often malnourished and have diminished immunity. H&N surgery with free tissue transfer reconstruction (HNS-FTTR) is associated with a relatively high incidence of postoperative complications. Methods Associations between possible risk factors and postoperative Clavien–Dindo (C–D) grades ≥ II and ≥ IIIa wound healing- or infection-related complications, postoperative overall complications and prolonged hospital stay were investigated in 188 patients who underwent HNS-FTTR during 2014–2018. The preoperative prognostic nutritional index (PNI) was calculated using the serum albumin level and total lymphocyte count. Results C–D ≥ II and ≥ IIIa complications were seen in 66 (35.1%) and 37 (19.7%) patients, respectively. Multivariate analysis showed that (i) previous irradiation was significantly associated with C–D ≥ II wound healing- or infection-related complications and prolonged hospital stays [odds ratio (OR) 3.096 and 3.328; P = 0.007 and 0.008, respectively]; and (ii) operation time of ≥9 h 20 min was a significant risk factor for C–D ≥ IIIa wound healing- or infection-related complications, and C–D ≥ IIIa overall complications (OR 2.987 and 2.257; P = 0.021 and 0.047, respectively). (3) Only preoperative PNI ≤ 40 was associated with all occurrences of C–D ≥ II and ≥ IIIa wound healing- or infection-related complications, C–D ≥ II and ≥ IIIa overall complications, and prolonged hospital stays (OR 3.078, 2.918, 2.627, 3.132 and 3.116; P = 0.020, 0.046, 0.036, 0.023 and 0.025, respectively). Conclusions PNI, easily calculated, was the lone risk factor significantly predicting all C–D ≥ II and ≥ IIIa postoperative wound healing- or infection-related complications, C–D ≥ II and ≥ IIIa postoperative overall complications and prolonged hospital stay after HNS-FTTR.

The role of prognostic nutritional index for clinical outcomes of gastric cancer after total gastrectomy

“…www.nature.com/scientificreports/ of cancer patients [16][17][18][19][20][21][22] . Malnutrition and low immune function not only affect the treatment effect of patients with malignant tumors, but also make malignant tumors more prone to relapse and metastasis 17 .…”

“…Compared with patients with normal nutritional status and immune function, the prognosis of those with poor nutritional status and immune function are also poor. A large number of studies have shown that immune nutrition status can be used as a powerful indicator to predict the survival outcome of patients with malignant tumors [19][20][21][22] . Onodera first confirmed the prognostic role of PNI in gastrointestinal surgery of malnourished cancer patients in 1984 23 .…”

Expert Consensus Statement on the Perioperative Management of Adult Patients Undergoing Head and Neck Surgery and Free Tissue Reconstruction From the Society for Head and Neck Anesthesia

“…Head and neck cancer patients are often malnourished or unable to feed properly due to the presence of a mass obstructing or compressing the upper aerodigestive tract. [6][7][8][9][10][11] Indexes that describe poor…”

Enhanced recovery and medical management after head and neck microvascular reconstruction

“…Originally developed in 1984 to screen surgical candidates for malnutrition prior to gastrointestinal surgery, Onodera's prognostic nutritional index (PNI) has gained significant traction as a preferred nutritional screen prior to head and neck surgery [24] . PNI uses a simple formula [Figure 2] to calculate a nutritional score with just two variables: serum albumin and total lymphocyte count.…”