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Influence of Body Mass Index on Perioperative Outcomes of Oncologic Microvascular Head and Neck Reconstruction: Comprehensive Analysis Using a Prospective Cohort
Hong Hao Xu
*1, Elizabeth D. Dominguez
3, Vanessa Mroueh
2, G. Zehra Kocyigit
1, Armin Aryannejad
1, Adriana M. Duncan
1, Matthew T. Bottegal
1, Mario G. Solari
11Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA; 2Department of Surgery, NYU Langone Health, New York, NY; 3Division of Plastic & Reconstructive Surgery, University of Nebraska Medical Center, Omaha, NE
Background: The impact of body mass index (BMI) extremes on the outcomes after head and neck cancer (HNC) reconstruction remains incompletely defined. We evaluated the influence of low and high BMI on the intraoperative and postoperative outcomes of oncologic head and neck microvascular reconstruction.
Methods: We analyzed a prospective institutional database (2019-2024). Patients were stratified into underweight (<18.5 kg/m
2), normal weight (≥18.5, <25), overweight (≥25, <30), and obesity classes I (≥30, <35), II (≥35, <40), and III (≥40). Flaps were categorized by donor site (thigh, back, fibula, or forearm). Demographics, intraoperative events, and donor-site, recipient-site, and systemic postoperative complications, were assessed.
Results: Among 542 patients, BMI distribution was: 9.6% underweight (n=52), 34.7% normal weight (n=188), 29.5% overweight (n=160), and 15.5% (n=84), 7.0% (n=38), and 3.7% (n=20) within obesity class I, II, and III, respectively. Underweight patients demonstrated higher rates of intraoperative anastomotic issues at 19.2% (
P=0.0434), and increased odds of both donor site (OR 4.60;
P=0.011) and recipient site (OR 2.49;
P=0.007) complications, particularly salivary leaks (24.0% vs ≤11.2%;
P=0.0322). In subgroup analyses, obesity II patients undergoing thigh-based reconstructions saw increased flap loss rates (16.7% vs ≤2.4%,
P=0.0002); obesity II and III patients demonstrated non-significant trends towards increased recipient-site hematoma (16.7% vs ≤3.6%,
P=0.1376) and dehiscence (20.0% vs ≤7.1%,
P=0.0824), respectively.
Conclusions: Extremes of BMI are associated with increased perioperative risk in HNC microvascular reconstruction. Underweight status is linked to elevated intraoperative and postoperative complications across flap types, while obesity related risk concentrates in class II/III patients undergoing thigh based reconstruction. These findings support BMI-informed preoperative risk stratification, optimization, and flap selection.
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