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

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 ti...

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Vydané v:Journal of reconstructive microsurgery Ročník 36; číslo 5; s. 369
Hlavní autori: Alwani, Mohamedkazim M, Jones, Alexander J, Novinger, Leah J, Pittelkow, Eric, Bonetto, Andrea, Sim, Michael W, Moore, Michael G, Mantravadi, Avinash V
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States 01.06.2020
Predmet:
Case-Control Studies
Female
Head and Neck Neoplasms - surgery
Humans
Male
Middle Aged
Postoperative Complications
Prognosis
Reconstructive Surgical Procedures - methods
Retrospective Studies
Risk Factors
Sarcopenia - complications
Surgical Flaps
ISSN:1098-8947, 1098-8947
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Shrnutí: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).  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, cm ). Skeletal muscle index (SMI, cm /m ) was calculated by normalizing CSA to patient height. Sarcopenia at L3 was defined as SMI ≤ 41.6 cm /m for males and ≤ 32.0 cm /m for females. Data analyses were performed to compare postoperative outcomes.  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,  = 0.017), had lower body mass index (BMI; 21.2 vs. 27.2,  < 0.001), had greater incidence of alcohol abuse (55.3 vs. 23.1%, OR = 4.11,  < 0.001). Intraoperatively, sarcopenic patients were found to have greater rates of blood transfusions (63.8 vs. 29.8%,  < 0.001). Postoperatively, sarcopenic patients had higher rates of pneumonia (  < 0.01), venous thromboembolism (  < 0.01), prolonged ventilation (  < 0.01), delirium (  < 0.01), fistula (  < 0.05), wound disruption (  < 0.05), and longer intensive care unit stays (  < 0.05). Sarcopenic patients were ultimately found to have higher overall rates of general postoperative complications (  < 0.001) and flap-specific complications (  < 0.01).  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.
Bibliografia:ObjectType-Article-1
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content type line 23
ISSN:1098-8947
1098-8947
DOI:10.1055/s-0040-1701696