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Program Number: B305
Session Name: Poster Session

Analysis of Body Mass Index in Head and Neck Free Flap Reconstruction and the Impact on Perioperative Complications and Outcomes

Madeline P Pyle, MD¹; Dina Modlin, BS¹; Elise Krippaehne²; Nicolaus D Knight, MS³; Javier K Nishikawa, BS³; Yasaman Baghshomali²; Madeline Otto²; Sumanth Chandrupatla³; Sruti Tekumalla, BA⁴; Dev Amin, MD⁴; Caroline Bonaventure, MD⁵; Farshid Taghizadeh, MD²; Peter Dziegielewski, MD⁶; Sallie Long, MD¹; Carissa M Thomas, MD³; Joseph M Curry, MD⁴; Michael DiLeo, MD⁵; Mark K Wax, MD²; Jason Leibowitz, MD¹; Larissa Sweeny, MD¹; ¹University of Miami; ²Oregon Health and Sciences University; ³University of Alabama at Birmingham; ⁴Thomas Jefferson University; ⁵Louisiana State University Health Science Center; ⁶University of Florida

Introduction: Head and neck surgeons are often faced with evaluating free flap candidacy in both underweight cancer patients and epidemic levels of obese patients in the United States.  Despite this, there is limited and conflicting evidence on the effect of low or high body mass index (BMI) on perioperative complications and free flap failure.

Objective: Examine the risk of perioperative complications, including those related to free flap compromise, stratified by BMI in patients undergoing free flap reconstruction of the head and neck.   

Methods: A multi-institutional, retrospective review of 2,239 patients who underwent head and neck free flap reconstruction at four tertiary academic medical centers from 2010-2021 was conducted. Patients were stratified by BMI (underweight, normal, overweight, and obese). Patient characteristics, comorbidities, outcomes, and perioperative complications were compared using ANOVA, Chi-square, Tukey test, and binary logistic regression.

Results: Underweight patients had significantly increased length of stay by 2 days (mean 12.2 ± 12.6 days) compared to normal (10.2 ± 9.5, p<0.049), overweight (10 ± 15.5, p<0.0416), and obese (8.9 ± 6.2, p<0.001) patients and increased operative time (mean 10.5 ± 3.4 hours) compared to normal (9.7 ± 3.5, p<0.022), overweight (9.6 ±3.5 p<0.012), and obese (9.5 ± 3.3, p<0.003).  Underweight status conferred increased risk of post-operative pulmonary complications compared to normal (OR 1.79, 95% CI: 1.08-2.96, p<0.023), overweight (OR 2.77, CI: 1.55-4.92, p<0.005), and obese (OR 2.38, CI: 1.29-4.36, p<0.005).  Underweight patients also had increased risk of post-operative delirium compared to normal (OR 1.87, CI: 1.06-3.29, p<0.029) and overweight (OR 2.57, CI: 1.36-4.84, p<0.0035), but not obese (OR 1.84, CI: 0.96-3.50, p<0.062) patients. Underweight patients did not have increased wound dehiscence compared to normal BMI (OR 1.31, CI: 0.92-1.88, p<0.14); however, they did have higher risk compared to obese (OR 2.06, CI: 1.35-3.14,  p<0.008) and overweight (OR 1.55, CI: 1.06-2.26, p<0.024) patients. Obesity was protective for wound dehiscence compared to patients with normal BMI (OR 0.64, CI: 0.46-0.88, p<0.006). There was no significant difference in flap failure between BMI groups.

Conclusion: Underweight BMI was significantly associated with increased length of stay, operative time, perioperative pulmonary complications, and perioperative delirium.  Understanding that free flap failure is not associated with BMI and identifying increased risks for perioperative complications, especially in underweight patients, can help guide pre-operative risk assessment and counseling for major free flap surgery.

 

 

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