Preoperative Hypoalbuminemia Predicts 30-day Complications in Head and Neck Microvascular Surgery

James R Xu; Anish Kosanam; Khashayar Arianpour; Eric D Lamarre; Christopher G Hyland; Peter J Ciolek

doi:10.1002/lary.31716

Preoperative Hypoalbuminemia Predicts 30-day Complications in Head and Neck Microvascular Surgery

Laryngoscope. 2024 Aug 21. doi: 10.1002/lary.31716. Online ahead of print.

Authors

James R Xu^{1

2}, Anish Kosanam^{1

2}, Khashayar Arianpour², Eric D Lamarre², Christopher G Hyland², Peter J Ciolek²

Affiliations

¹ Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A.
² Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.

PMID: 39166736
DOI: 10.1002/lary.31716

Abstract

Introduction: Hypoalbuminemia, a marker for poor nutritional status, has been associated with postoperative complications, including head and neck cancer surgery. This study investigates the impact of hypoalbuminemia on head and neck microvascular free tissue transfer reconstruction.

Methods: This retrospective cohort study queried the 2005-2021 American College of Surgeons National Surgical Quality Improvement Program databases. Reconstructive cases performed by otolaryngologists (CPT: 15756, 15757, 15758, 15842, 20955, 20956, 20957, 20962, 20969, 20970, 20972, 20973, 43116, 43496, 49006, and 49906) with available preoperative albumin, BMI, and age were included. Hypoalbuminemia was defined as a preoperative albumin <3.5 g/dL. Univariate and multivariable logistic regression were performed.

Results: A total of 3,886 cases met the inclusion criteria, of which 835 (21.5%) had hypoalbuminemia. The hypoalbuminemia cohort was older, had lower BMI, had higher ASA classification, and had worse functional health status. Adjusted multivariable logistic regression showed that hypoalbuminemia was associated with unplanned return to the operating room within 30 days (OR: 1.36, p < 0.01), unplanned reoperation (OR: 1.36, p < 0.01), any complication (OR: 1.77, p < 0.01), surgical complications (OR: 1.94, p < 0.01), and medical complications (OR: 1.34, p = 0.01). Hypoalbuminemia was correlated with a longer hospital stay, superficial surgical site infection, wound dehiscence, transfusion, deep vein thrombosis, and acute renal failure.

Conclusion: Hypoalbuminemia is a risk factor for postoperative complications after microvascular free tissue transfer for head and neck reconstruction. This study suggests that preoperative optimization of hypoalbuminemia may be beneficial for these patients.

Level of evidence: 3 Laryngoscope, 2024.

Keywords: free flap; head and neck reconstruction; hypoalbuminemia; malnutrition; microvascular surgery; surgical outcomes.