Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Patients with laryngeal malignancies often require open laryngeal surgery as part of their treatment but are at risk of weight loss and malnutrition. Malnutrition may impair immune function, negatively impacting wound healing and surgical outcomes. Studies have correlated poor nutritional status with fistula formation and other wound complications following laryngectomies. A detailed understanding of how underweight status affects surgical results is crucial for effective perioperative management. This study employs the American College of Surgeons (ACS) National Surgical Quality Improvement database (NSQIP) for a more comprehensive analysis of perioperative outcomes based on patient nutritional status.
Methods: The NSQIP database was queried for CPT codes describing open total or partial laryngectomies. In total, 2,148 cases from 2005-2020 involving underweight (BMI <18.5) or normal weight (BMI 18.5-29.9) patients were included; cases involving obese patients (BMI ≥30) or patients missing height and weight data (n=29) were excluded. Patients who unintentionally lost 10% of their body weight within 6 months preceding their surgeries were analyzed as a separate group. Statistical analyses, including Chi-squared, Monte Carlo, and Mann-Whitney U tests, were performed using SPSS. The significance was set at p<.05.
Results: Underweight patients experienced significantly higher rates of overall medical complications (p<.001) and wound disruptions (p=.002), and also experienced longer hospital stays (p<.001). Underweight patients were at higher risk of bleeding events that required a transfusion within 72 hours post-surgery (p<.001) and of being discharged to a non-home setting (p=.008). However, underweight status was not associated with increased mean operation time (p=.070) or 30-day mortality rates (p=.281). Among patients who experienced recent weight loss, underweight individuals were still at significantly increased risk of overall medical complications (p=.044) and transfusions for bleeding within 72 hours of surgery (p<.001). These patients were not at increased risk for wound disruptions (p=.056) or longer total hospital stays (p=.221).
Discussion: These findings highlight malnutrition as a risk factor for complications following laryngeal surgery. Underweight patients face impaired wound healing and longer hospital stays—factors associated with poorer physical and mental health outcomes and increased patient costs. Preoperative nutritional optimization may improve post-operative recovery for patients undergoing partial or total laryngectomies.
The insignificant difference in risk of wound dehiscence between the underweight and normal BMI patients within the recent weight loss subgroup may reflect differences in the effects of acute versus chronic weight loss on immune function and tissue repair. Nutritional deficits from acute weight loss may not compromise healing as severely as chronic malnutrition does.
In underweight patients with recent weight loss, greater emphasis should be placed on assessing bleeding risks through preoperative coagulation panels, intraoperative hemodynamic monitoring, and minimizing blood loss. Postoperative drain checks and hemoglobin monitoring could further enhance outcomes. Implementing these strategies could address the needs of underweight patients by improving surgical outcomes and reducing the cost of care. Future research should investigate long-term outcomes for underweight patients and assess the effectiveness of targeted interventions to prevent complications, enhancing our understanding of nutrition's role in surgical recovery.