Xu James R, Kosanam Anish, Arianpour Khashayar, Lamarre Eric D, Hyland Christopher G, Ciolek Peter J
Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A.
Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Laryngoscope. 2025 Feb;135(2):648-656. doi: 10.1002/lary.31716. Epub 2024 Aug 21.
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.
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.
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.
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.
3 Laryngoscope, 135:648-656, 2025.
低白蛋白血症是营养状况不佳的一个指标，与包括头颈癌手术在内的术后并发症有关。本研究调查低白蛋白血症对头颈微血管游离组织移植重建的影响。
这项回顾性队列研究查询了2005 - 2021年美国外科医师学会国家外科质量改进计划数据库。纳入了由耳鼻喉科医生进行的重建病例（CPT编码：15756、15757、15758、15842、20955、20956、20957、20962、20969、20970、20972、20973、43116、43496、49006和49906），这些病例术前白蛋白、BMI和年龄数据可用。低白蛋白血症定义为术前白蛋白<3.5 g/dL。进行单因素和多因素逻辑回归分析。
共有3886例病例符合纳入标准，其中835例（21.5%）存在低白蛋白血症。低白蛋白血症组患者年龄更大、BMI更低、ASA分级更高且功能健康状况更差。校正后的多因素逻辑回归分析显示，低白蛋白血症与30天内非计划重返手术室（比值比：1.36，p < 0.01）、非计划再次手术（比值比：1.36，p < 0.01）、任何并发症（比值比：1.77，p < 0.01）、手术并发症（比值比：1.94，p < 0.01）以及医疗并发症（比值比：1.34，p = 0.01）相关。低白蛋白血症与住院时间延长、手术部位浅表感染、伤口裂开、输血、深静脉血栓形成和急性肾衰竭相关。
低白蛋白血症是头颈重建微血管游离组织移植术后并发症的一个危险因素。本研究表明，术前改善低白蛋白血症状况可能对这些患者有益。
3 喉镜，135:648 - 656，2025年。
