Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: 25-hydroxyvitamin D (vitamin D3) is a well-documented biomarker in successful wound healing; however, current surgical literature reports conflicting conclusions when looking at vitamin D3 levels and postoperative outcomes. For vulnerable patient populations receiving surgery, such as those with extensive head and neck cancer needing flap reconstruction, the role of vitamin D remains unclear. Published studies on this topic specifically within otolaryngologic surgery are predominantly made up of small cohorts with heterogenous populations. Reports on use of vitamin D as a biomarker in advanced reconstruction of complex head and neck pathology are lacking. In this study we aim to elucidate the effects of vitamin D deficiency on postoperative flap outcomes in patients receiving reconstruction for head and neck cancer.
Methods: A retrospective cohort study was conducted using the TriNetX Research Network, a deidentified insurance claims database. Thirty-seven health care organizations were recruited. Patients with free/pedicled flap reconstruction for head and neck cancer were queried. A vitamin D3 level or D2/D3 panel was required to be documented anytime 1 year before to 1 year after surgery. Vitamin D deficiency (VDD) was defined as a level less than or equal to 24 ng/mL, and sufficiency (VDS) was defined as a level greater than or equal to 24.1 ng/mL. Both cohorts were compared to assess differences in postoperative outcomes, up to 30 days postoperatively. Outcomes included flap revision/take back, deep venous thrombosis, infection or sepsis, fistula or dehiscence, pneumonia, and inpatient length of stay. Cohorts were matched for age, sex, ethnicity, tobacco use, type II diabetes mellitus, and chronic kidney disease. Measures of association tests were employed to measure difference in outcome incidences between groups, and significance was measured at p<0.05.
Results: After matching, there were 466 patients in each cohort. Average ages at time of surgery were 62.8 ± 11.3 and 62.6 ± 11.7 years in VDS and VDD groups, respectively. About 31% of each cohort was female. After matching, VDS and VDD groups had similar numbers of lip/oral cavity/pharyngeal cancers (65% vs 60%) and laryngeal cancers (14% vs 19%). Before matching, vitamin D levels were 39.4 ± 13.9 ng/mL and 17.6 ± 5.56 ng/mL for VDS and VDD, respectively. VDS and VDD patients had lengths of stay of 7.56 and 7.20 days, respectively. Before and after matching for confounders affecting wound healing, there were no statistically significant differences seen between VDS and VDD cohorts in postoperative outcomes.
Conclusions: Overall, there were no significant differences seen between VDD and VDS cohorts up to 1 month after surgery after controlling for potential confounders. Our findings do not align with previous reports of increased postoperative complications in vitamin D deficiency. To our knowledge, this is the first large database study assessing correlation between vitamin D level and on postoperative flap outcomes for patients with head and neck cancer.