Impact of Body Mass Index on Operative Outcomes in Head and Neck Free Flap Surgery

Crippen, Meghan M.; Brady, Jacob S.; Mozeika, Alexander M.; Eloy, Jean Anderson; Baredes, Soly; Park, Richard Chan Woo

doi:10.1177/0194599818777240

Cited by 36 publications

(53 citation statements)

References 27 publications

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“…In the present study, any preoperative weight loss had a statistically significant association with severe surgical complications, whereas the WHO's definition of underweight did not. Reporting weight loss as a stronger predictor of complications than underweight has been shown in some published studies [23], whereas others do not confirm this [17,24]. Interestingly, stratified analysis among patients with obesity (BMI 30 kg/m 2 ) in the current study population demonstrated that weight loss increased the risk of severe surgical complications also in this group.…”

Section: Discussioncontrasting

confidence: 56%

Weight loss and BMI criteria in GLIM's definition of malnutrition is associated with postoperative complications following abdominal resections – Results from a National Quality Registry

et al. 2020

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Background & aims: Although malnutrition is thought to be common among patients with intraabdominal diseases and is recognized as a risk factor for postoperative complications, diagnostic criteria for malnutrition have not been consistent. Thus, the Global Leadership Initiative in Malnutrition (GLIM) has recently published new criteria for malnutrition. The aims of this study were to investigate the prevalence of malnutrition according to weight loss and BMI criteria in GLIM's second step for the diagnosis and their association with severe postoperative complications in patients undergoing gastrointestinal resections. Method: The current study includes adult patients who were prospectively included in the Norwegian Registry for Gastrointestinal Surgery in the period between 2015 and 2018. Exclusion criteria were acute surgery and lack of information regarding preoperative weight and/or postoperative complications. Severe surgical complications were classified according to the Revised Accordion Classification system and malnutrition with the GLIM criteria. Associations were assessed by logistic regression analyses, and the adjusted odds ratio included age (continuous), gender (male/female) and scores from the American Society of Anesthesiologists Physical Status Classification System and the Eastern Cooperative Oncology Group. Results: Out of 6110 patients, 2161 (35.4%) were classified as with malnutrition, 1206 (19.7%) with moderate and 955 (15.6%) with severe malnutrition. Malnourished patients were 1.29 (95% CI: 1.13e1.47) times more likely to develop severe surgical complications, and 2.15 (95% CI: 1.27e3.65) times more likely to die within 30 days, as compared to those who were not. Conclusion: Preoperative malnutrition is common among patients having gastrointestinal resections and is associated with an increased risk of severe surgical complications.

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Section: Discussioncontrasting

confidence: 56%

Weight loss and BMI criteria in GLIM's definition of malnutrition is associated with postoperative complications following abdominal resections – Results from a National Quality Registry

et al. 2020

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“…37 Consistent with our findings, studies utilizing BMI as an anthropometric measure to predict surgical outcomes in head and neck free flaps have concluded that BMI does not significantly influence postoperative outcomes in these patients. 38 A recent study by Crippen et al analyzed the impact of BMI on head and neck free flap surgery outcomes by evaluating medical and surgical complications in 2,187 patients from the NSQIP database. The study concluded that BMI does not significantly influence postoperative outcomes, similar to findings reported by Hyun et al 39 Thus, it is important to understand that BMI and SMI are distinct anthropometric measures without a strong correlation as demonstrated by our study (►Fig.…”

Section: Discussionmentioning

confidence: 99%

Impact of Sarcopenia on Outcomes of Autologous Head and Neck Free Tissue Reconstruction

Alwani

Jones

Novinger

et al. 2020

J Reconstr Microsurg

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Background Sarcopenia has been implicated as a positive predictor of postsurgical complications. Its role in head and neck (H&N) free flap reconstruction has yet to be examined. Our study aimed to determine the clinical impact of sarcopenia on postoperative outcomes in patients receiving autologous free tissue reconstruction for H&N cancer (HNC). Methods A retrospective case–control study was conducted at our tertiary referral center. Patients with HNC who received oncologic resection followed by autologous free tissue reconstruction were included. Preoperative abdominal computed tomography (CT) imaging was analyzed at the third lumbar vertebra (L3) to calculate skeletal muscle cross-sectional area (CSA, cm2). Skeletal muscle index (SMI, cm2/m2) was calculated by normalizing CSA to patient height. Sarcopenia at L3 was defined as SMI ≤ 41.6 cm2/m2 for males and ≤ 32.0 cm2/m2 for females. Data analyses were performed to compare postoperative outcomes. Results Of the 168 patients who met inclusion criteria, 47 patients (28.0%) were determined to have preoperative sarcopenia. The sarcopenic group was older (63 vs. 58 years, p = 0.017), had lower body mass index (BMI; 21.2 vs. 27.2, p < 0.001), had greater incidence of alcohol abuse (55.3 vs. 23.1%, OR = 4.11, p < 0.001). Intraoperatively, sarcopenic patients were found to have greater rates of blood transfusions (63.8 vs. 29.8%, p < 0.001). Postoperatively, sarcopenic patients had higher rates of pneumonia (p < 0.01), venous thromboembolism (p < 0.01), prolonged ventilation (p < 0.01), delirium (p < 0.01), fistula (p < 0.05), wound disruption (p < 0.05), and longer intensive care unit stays (p < 0.05). Sarcopenic patients were ultimately found to have higher overall rates of general postoperative complications (p < 0.001) and flap-specific complications (p < 0.01). Conclusion Sarcopenia was found to be a predictor of postoperative complications in H&N free flap reconstruction, signifying its value as a negative prognostic factor in surgical outcomes. This study reflects level of evidence IV.

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“…Recent nationwide analyses evaluating all modalities of microvascular H&N reconstruction have identified factors that are associated with postoperative complications, including anesthesia duration, low preoperative body weight, a longer length of postoperative hospital stay, age, and smoking status (Brady et al, 2018; Cannady et al, 2017; Crippen et al, 2018; White et al, 2015). However, these studies do not isolate outcomes of microvascular osseous reconstruction, nor do they parse out the comparative outcomes of BBFs and OCFs.…”

Section: Introductionmentioning

confidence: 99%

“…The most common types of osteocutaneous free flaps are harvested from the radial forearm, scapula, and fibula (Hanasono, Matros, & Disa, 2014). (Brady et al, 2018;Cannady et al, 2017;Crippen et al, 2018;White et al, 2015). However, these studies do not isolate outcomes of microvascular osseous reconstruction, nor do they parse out the comparative outcomes of BBFs and OCFs.…”

mentioning

confidence: 99%

Outcomes of microvascular bone flaps versus osteocutaneous flaps in head and neck reconstruction

et al. 2020

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Background: Surgical resection of head and neck (H&N) neoplasms requiring osseous reconstruction have underdefined complication profiles. This study aimed to characterize postoperative outcomes of patients with H&N neoplasia undergoing osteocutaneous flap (OCF) or bare bone flap (BBF) reconstructions. Materials and methods: Retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) 2005-2017 databases. Queried for diagnosis and procedural codes extracted patients with H&N neoplasms undergoing BBF or OCF reconstruction. Postoperative complications were evaluated. Multivariable regression generated adjusted odds ratios. Results: A cohort of 746 patients were identified. Of reconstructions, 24.9% (n = 186/746) were BBFs while 75.1% (n = 560/746) were OCFs. 58.1% of the BBF cohort and 59.9% of the OCF cohort experienced an all-cause complication (p = .654). Sub-stratified, 24.2% of BBF and 17.5% of OCF patients experienced a wound complication (p = .045). Regression analysis demonstrated no difference in risk for medical complications between cohorts. However, patients receiving OCFs had a decreased likelihood of developing a wound complication (OR 0.652; 95%CI 0.430-0.989; p = .044) compared to patients receiving BBFs. Conclusion: The incidence of complications following osseous reconstruction of the H&N is considerable. Although several complication outcomes do not seem to differ between BBF or OCF reconstructions, OCFs is associated with a decreased likelihood of wound complications. 1 | INTRODUCTION Benign and malignant neoplasms of the head and neck (H&N) exert significant global morbidity with H&N cancer occurring in more than 500,000 patients across the globe each year (Jemal et al., 2011). An estimated 65,000 of these new cases are annually diagnosed in the United States, of which 14,000 result in death (Cancer.net Editorial Board, n.d.). These statistics are further magnified by cutaneous malignancies localized to the H&N (Mydlarz, Weber, & Kupferman, 2015). Ultimately, the treatment of H&N neoplasms is multi-faceted and interdisciplinary involving medical, surgical, occupational, and psychological support (Wheless, McKinney, & Zanation, 2010). Surgical intervention is an integral aspect of H&N tumor management with excision dependent upon tumor location and characteristics (Carlson & McCoy, 2017; Fu, Foreman, Goldstein, & de Disclaimer: The ACS NSQIP databases are the source of information used in this study. Data extrapolated, statistical analysis performed, and conclusions reached have not been verified by the ACS NSQIP but rather are the result of the work done by authors of this study.

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Impact of Body Mass Index on Operative Outcomes in Head and Neck Free Flap Surgery

Cited by 36 publications

References 27 publications

Weight loss and BMI criteria in GLIM's definition of malnutrition is associated with postoperative complications following abdominal resections – Results from a National Quality Registry

Weight loss and BMI criteria in GLIM's definition of malnutrition is associated with postoperative complications following abdominal resections – Results from a National Quality Registry

Impact of Sarcopenia on Outcomes of Autologous Head and Neck Free Tissue Reconstruction

Outcomes of microvascular bone flaps versus osteocutaneous flaps in head and neck reconstruction

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