The association between the Nutrition‐Related index and morbidity following head and neck microsurgery

Abstract

Objectives/Hypothesis Despite consensus that preoperative nutritional assessment is of importance in the head and neck surgical oncology population, it remains unclear how exactly malnutrition is associated with perioperative morbidity especially among those undergoing microvascular surgery. We aimed to study this association to help inform preoperative risk stratification, guide the use of nutritional interventions, and ultimately help prevent malnutrition related morbidity. Study Design Database analysis. Methods Retrospective, linked analysis of the 2011 to 2016 National Surgical Quality Improvement Program. After identifying eligible patients and stratifying according to the Nutrition‐Related Index, a univariate screen of preoperative demographic and clinical covariates was performed. Subsequently, propensity score matching was utilized to control for differences in baseline covariates. Perioperative complications and mortality were then analyzed using the propensity score–matched cohorts. Results Among 977 identified patients, 276 (28.2%) were malnourished. Malnourished patients had higher rates of comorbidity, were more likely to actively smoke, and were more likely to have primaries in the oropharynx or hypopharynx/larynx. After propensity score matching to control for confounders, malnourished patients had higher rates of pulmonary complications (21.5% vs. 11.6%, P < .01), higher rates of bleeding or need for transfusion (56.6% vs. 43.0%, P < .01), higher rates of venous thromboembolism (3.7% vs. 0.8%, P = .03), and a higher 30‐day mortality rates (3.7% vs. 0.0%, P < .01). Conclusions This nationwide analysis finds that 28.2% of patients undergoing surgery for head and neck cancers with free flap reconstruction are malnourished. Malnourishment was found to be independently associated with postoperative pulmonary complications, bleeding or need for transfusion, and 30‐day mortality. Level of Evidence NA Laryngoscope, 130:375–380, 2020

Association between nutritional risk index and outcomes for head and neck cancer patients receiving concurrent chemo‐radiotherapy

“…17 Analysis with propensity score-matched cohort showed that malnourished group had more frequent pulmonary complications, more frequent blood transfusions, higher rates of venous thromboembolism, and higher 30-day mortality rates. 17 This is in keeping with the findings of our study that suggested that moderate nutritional risk as defined by NRI score less than 97.5 is associated with higher risk for complications. The study provides further evidence for NRI score as a prognostic tool in HNC patients undergoing curative intent treatment.…”

“…16 For descriptive statistics, patients were categorized as no malnourishment (>100), mild (97.5-100), moderate (97.5-83.5), and severe (<83.5) risk as per prior studies. 9,11,17 For time-dependent, survival, and treatment complication regression analysis, none and mild risk patients (NRI ≥ 97.5) were combined as a control group to compare with moderate and severe groups (NRI < 97.5) as per the prior studies supporting an NRI cut off value of 97.5, and to account for the small range of NRI scores in the mild risk group (97.5-100). 10,[17][18][19] The primary outcome was the change between the pretreatment NRI score and the posttreatment NRI score.…”

“…9,11,17 For time-dependent, survival, and treatment complication regression analysis, none and mild risk patients (NRI ≥ 97.5) were combined as a control group to compare with moderate and severe groups (NRI < 97.5) as per the prior studies supporting an NRI cut off value of 97.5, and to account for the small range of NRI scores in the mild risk group (97.5-100). 10,[17][18][19] The primary outcome was the change between the pretreatment NRI score and the posttreatment NRI score. Secondary outcomes were overall survival and a composite of treatment complications, including (a) G-tube dependence at 1 year, (b) radiation incompletion, (c) 90-day mortality, and (d) unplanned hospitalization rate.…”

Causes of nutrition deficit during immediate postoperative period after free flap surgery for cancer of the head and neck

“…The ideal body weight (IBW) was calculated for each patient using the Devine formula for men and the Robinson formula for women [11]. The energy demand during the study period was calculated individually for each patient using the ideal weight and the estimate of 30 kcal/kg/day, which was derived from both the ESPEN guidelines for surgical patients and from the national nutritional guidelines of the UK for HNC patients [1,10].…”

“…Although HNC free flap surgery may have a substantial impact on normal eating, chewing and swallowing, there is a lack of studies contemplating the adequacy of nutrition during the immediate postoperative period. Studies concerning the postoperative nutrition of hospitalized HNC patients have mostly been focusing on the preceding prevalence of malnutrition [11,12] and optimal initiation of oral food intake such as in laryngectomized patients in terms of pharyngocutaneus fistula formation [13][14][15].…”