Preoperative prognostic nutritional index as a method to predict postoperative complications after major head and neck surgery with free tissue transfer reconstruction.

Abstract

Head and neck (H&N) cancer patients are often malnourished and have diminished immunity. H&N surgery with free tissue transfer reconstruction (HNS-FTTR) is associated with a relatively high incidence of postoperative complications. Associations between possible risk factors and postoperative Clavien-Dindo (C-D) grades ≥ II and≥ IIIa wound healing- or infection-related complications, postoperative overall complications and prolonged hospital stay were investigated in 188 patients who underwent HNS-FTTR during 2014-2018. The preoperative prognostic nutritional index (PNI) was calculated using the serum albumin level and total lymphocyte count. C-D≥II and≥IIIa complications were seen in 66 (35.1%) and 37 (19.7%) patients, respectively. Multivariate analysis showed that (i) previous irradiation was significantly associated with C-D≥II wound healing- or infection-related complications and prolonged hospital stays [odds ratio (OR) 3.096 and 3.328; P=0.007 and 0.008, respectively]; and (ii) operation time of ≥9h 20min was a significant risk factor for C-D≥IIIa wound healing- or infection-related complications, and C-D≥IIIa overall complications (OR 2.987 and 2.257; P=0.021 and 0.047, respectively). (3) Only preoperative PNI ≤ 40 was associated with all occurrences of C-D≥II and≥IIIa wound healing- or infection-related complications, C-D≥II and≥IIIa overall complications, and prolonged hospital stays (OR 3.078, 2.918, 2.627, 3.132 and 3.116; P=0.020, 0.046, 0.036, 0.023 and 0.025, respectively). PNI, easily calculated, was the lone risk factor significantly predicting all C-D≥II and≥IIIa postoperative wound healing- or infection-related complications, C-D≥II and≥IIIa postoperative overall complications and prolonged hospital stay after HNS-FTTR.