Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2019

Investigating the effects of nutritional status on post-operative complications in a head and neck cancer surgical population (#341)

Alice Pashley 1 , Teresa Brown 1 2 , Belinda Lehn 3 , Robert Hodge 4 , Judy Bauer 1
  1. Human Movement and Nutrition Science, University of Queensland, Brisbane, QLD, Australia
  2. Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
  3. Speech Pathology and Audiology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
  4. Ear Nose and Throat, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia

Aims

Malnutrition is an important prognostic indicator of post-operative outcomes in patients undergoing surgery for head and neck cancer. However there are limited studies utilising validated nutrition assessment tools to determine the nutritional status. This study aimed to assess the incidence of malnutrition using a validated nutrition assessment tool, and to determine the relationship between pre-operative nutritional status with post-operative clinical outcomes in a surgical population with head and neck cancer.

Methods

A retrospective chart audit was conducted for patients with head and neck cancer undergoing laryngectomy or pharyngolaryngectomy between 2012 and 2014 (n=43) at a large tertiary hospital in Australia. Baseline nutritional status was measured by the dietitian on admission using the Subjective Global Assessment (SGA) tool. Clinical outcomes include length of stay (LOS) and post-operative complications (wound infection or dehiscence, fistula, ICU admission, anastomotic leaks, pressure injuries). Multivariate analysis using logistic regression was used to determine relationship of malnutrition on outcomes.

Results

A pre-surgical malnutrition rate of 37.2% was observed. Malnourished patients were more likely to experience any complication than well-nourished patients (80% vs 44% respectively) however this was not statistically significant (OR 3.7, 95% CI 0.6 to 23.5; P = 0.159). Pressure injury was the only complication found to be statistically associated with nutrition status (OR 15.6, 95% CI 1.7 to 146.4; P = 0.016). Well-nourished patients had a mean LOS of 20.1 days, compared to 25.3 days for malnourished patients (U = 164, P = 0.190), which has clinical significance and financial implications.

Conclusion

This study showed a high rate of malnutrition pre-operatively and that poorer nutritional status was found to put patients at higher risk for experiencing post-operative complications and having a longer duration of hospitalisation. Validated nutrition assessment tools should be routinely used to identify patients pre-operatively for early nutrition intervention.