Meghan M Crippen1, Jacob S Brady1, Alexander M Mozeika1, Jean Anderson Eloy1,2,3,4, Soly Baredes1,2, Richard Chan Woo Park1. 1. 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA. 2. 2 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA. 3. 3 Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA. 4. 4 Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Abstract
OBJECTIVE: Analyze the risk for perioperative complications associated with body mass index (BMI) class in patients undergoing head and neck free flap reconstruction. STUDY DESIGN AND SETTING: Retrospective cohort study. SUBJECTS AND METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried for all cases of head and neck free flaps between 2005 and 2014 (N = 2187). This population was stratified into underweight, normal-weight, overweight, and obese BMI cohorts. Groups were compared for demographics, comorbidities, and procedure-related variables. Rates of postoperative complications were compared between groups using χ2 and binary logistic regression analyses. RESULTS: Underweight patients (n = 160) had significantly higher rates of numerous comorbidities, including disseminated cancer, preoperative chemotherapy, and anemia, while obese patients (n = 447) had higher rates of diabetes and hypertension. Rates of overall surgical complications, medical complications, and flap loss were insignificantly different between BMI groups. Following regression, obese BMI was protective for perioperative transfusion requirement (odds ratio [OR] = 0.63, P = .001), while underweight status conferred increased risk (OR = 2.43, P < .001). Recent weight loss was found to be an independent predictor of perioperative cardiac arrest (OR = 3.16, P = .006) while underweight BMI was not (OR = 1.21, P = .763). However, both weight loss and underweight status were associated with significantly increased risk for 30-day mortality (OR = 4.48, P = .032; OR = 4.02, P = .010, respectively). CONCLUSION: Obesity does not increase the risk for postoperative complications in head and neck free flap surgery and may be protective in some cases. When assessing a patient's fitness for surgery, underweight status or recent weight loss may suggest a reduced ability to tolerate extensive free flap reconstruction.
OBJECTIVE: Analyze the risk for perioperative complications associated with body mass index (BMI) class in patients undergoing head and neck free flap reconstruction. STUDY DESIGN AND SETTING: Retrospective cohort study. SUBJECTS AND METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried for all cases of head and neck free flaps between 2005 and 2014 (N = 2187). This population was stratified into underweight, normal-weight, overweight, and obese BMI cohorts. Groups were compared for demographics, comorbidities, and procedure-related variables. Rates of postoperative complications were compared between groups using χ2 and binary logistic regression analyses. RESULTS: Underweight patients (n = 160) had significantly higher rates of numerous comorbidities, including disseminated cancer, preoperative chemotherapy, and anemia, while obesepatients (n = 447) had higher rates of diabetes and hypertension. Rates of overall surgical complications, medical complications, and flap loss were insignificantly different between BMI groups. Following regression, obese BMI was protective for perioperative transfusion requirement (odds ratio [OR] = 0.63, P = .001), while underweight status conferred increased risk (OR = 2.43, P < .001). Recent weight loss was found to be an independent predictor of perioperative cardiac arrest (OR = 3.16, P = .006) while underweight BMI was not (OR = 1.21, P = .763). However, both weight loss and underweight status were associated with significantly increased risk for 30-day mortality (OR = 4.48, P = .032; OR = 4.02, P = .010, respectively). CONCLUSION: Obesity does not increase the risk for postoperative complications in head and neck free flap surgery and may be protective in some cases. When assessing a patient's fitness for surgery, underweight status or recent weight loss may suggest a reduced ability to tolerate extensive free flap reconstruction.
Entities:
Keywords:
BMI; NSQIP; cachexia; database; free flaps; head and neck cancer; obesity; otolaryngology; retrospective
Authors: Thomas F Barrett; Angela L Mazul; Katelyn O Stepan; C Burton Wood; Randall C Paniello; Jose P Zevallos; Sean Massa; Ryan S Jackson; Nicole C Schmitt; Joseph Zenga; Stephen Y Kang; Patrik Pipkorn; Jason T Rich; Sidharth V Puram Journal: Oral Oncol Date: 2021-05-12 Impact factor: 5.972
Authors: Alexander Joseph Jones; Vincent J Campiti; Mohamedkazim Alwani; Leah J Novinger; Brady Jay Tucker; Andrea Bonetto; Jessica A Yesensky; Michael W Sim; Michael G Moore; Avinash V Mantravadi Journal: Laryngoscope Investig Otolaryngol Date: 2021-01-31