Micronutrient Depletion and Protein-Energy Malnutrition in Head and Neck Reconstructive Surgery.
OBJECTIVE We aimed to describe the prevalence of preoperative micronutrient abnormalities, protein-energy malnutrition (PEM), and their association with postoperative complications in patients undergoing head and neck free flap reconstruction (HNFFR). METHODS A single institution, retrospective cohort study of adults requiring HNFFR was performed. Patient data and pre-operative serological parameters were extracted from the electronic medical record. Nutritional status was assessed by the Patient Generated-Subjective Global Assessment (PG-SGA) tool. RESULTS About 261 patients met inclusion criteria with the predominant undergoing surgery involving the oral cavity (n = 203; 77.8%). The combined prevalence of moderate and severe malnutrition was 27.2%. Hypovitaminosis C was present in 64 patients (36.8%) and was associated with an increased likelihood of a complication on both univariate (OR 1.9 [1.01-3.51; 95% CI]) and multivariate (OR 2.2 [1.12-4.29; 95% CI]) analysis. On further subgroup univariate analysis, increased age, hypertension, macrocytosis, PG-SGA score and moderate malnutrition were associated with postoperative medical complications. An increased length of stay was also associated with complications on univariate and multivariate analysis. CONCLUSION Hypovitaminosis C was associated with an increased risk of postoperative complications. Early screening and intervention for micronutrient depletion and PEM prior to surgery may reduce these risks for patients undergoing HNFFR. LEVEL OF EVIDENCE: 3