Micronutrient Depletion and Protein-Energy Malnutrition in Head and Neck Reconstructive Surgery

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).

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.

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.

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.