Early postoperative serum albumin levels as predictors of surgical outcomes in head and neck squamous cell carcinoma

Reis, Tercio Guimarães; Silva, Richard Alex Wesler Prudêncio da; Nascimento, Eliane dos Santos; Bessa Júnior, José de; Oliveira, Márcio Campos; Fava, Antônio Sérgio; Lehn, Carlos Neutzling

doi:10.1016/j.bjorl.2021.03.004

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Brazilian Journal of Otorhinolaryngology

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Brasil

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Sumário

Original article • Braz. j. otorhinolaryngol. 88 (Suppl 1) • 2022 • https://doi.org/10.1016/j.bjorl.2021.03.004 copy

Early postoperative serum albumin levels as predictors of surgical outcomes in head and neck squamous cell carcinoma

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHTS

First-postoperative day (POD) serum albumin is a predictor of complications in head and neck surgery.

First-POD albumin <2.8 g/dl increases the risk of postoperative complications.

Non-complicated patients normalize serum albumin more often and five times more rapidly.

Abstract

Background

Malnutrition is a common issue in patients with head and neck squamous cell carcinoma and has a negative effect on surgical outcomes.

Objective

We attempted to determine which malnutrition diagnostic variables can be used as predictors of postoperative complications in patients with head and neck squamous cell carcinoma.

Methods

Forty-one patients undergoing surgery for head and neck squamous cell carcinoma were submitted to a prospective evaluation. Biochemical data, anthropometric measurements and evaluation of body composition were used in the nutritional analysis.

Results

Twenty-two patients (53.6%) developed complications. Serum albumin measured on the first postoperative day was the only variable that significantly differed between groups. A cut-off value of 2.8 g/dL distinguished between patients with a complicated and uncomplicated postoperative course. Normalization of albumin levels occurred more frequently and more rapidly in the noncomplicated group.

Conclusion

Serum albumin measured on the first postoperative day was the only variable that was a predicter of postoperative complications after major head and neck squamous cell carcinoma surgery.

Keywords
Malnutrition; Head and neck neoplasms; Nutrition assessment; Serum albumin; Postoperative complications

	Complicated (n = 22)	Noncomplicated (n = 19)	p-Value
Age	61.32 ± 10.77	61.57 ± 10.42	0.941
Sex
Male	18 (82%)	18 (95%)	0.707
Female	4 (18%)	1 (5%)
Monthly income ^a a Monthly minimum wage in 2008: R$450.00.9
Up to 3 times the minimum wage	9 (41%)	8 (42%)	0.969
Between 3 and 7 times the minimum wage	10 (45.4%)	8 (42%)
>7 times the minimum wage	3 (13.6%)	3 (16%)
Education level ^b b Law on Brazilian Education Guidelines and Bases (9,394/1996).10
Illiterate	1 (4.5%)	0	0.531
Incomplete primary education	10 (45.5%)	8 (42.1%)
Complete primary education	4 (18.2%)	6 (31.6%)
Incomplete secondary education	1 (4.5%)	3 (15.8%)
Complete secondary education	2 (9.1%)	0
Higher education	4 (18.2%)	2 (10.5%)
Primary tumor subsite
Oral cavity	9 (40%)	6 (31.6%)	0.083
Oropharynx	6 (27.3%)	1 (5.2%)
Hypopharynx	3 (13.6%)	2 (10.5%)
Larynx	4 (18.2%)	10 (52.7%)
Clinical stage
II	2 (9.1%)	4 (10.5%)	0.533
III	7 (31.8%)	6 (31.6%)
IV	13 (59.1%)	9 (47.4%)
T (tumor size)
T2	4 (18.2%)	7 (36.8%)	0.339
T3	11 (50%)	6 (31.6%)
T4	7 (31.8%)	6 (31.6%)
Flap reconstruction
Yes	7 (31.8%)	4 (21.1%)	0.437
No	15 (68.2%)	15 (78.9%)
Blood transfusion
No	11 (50%)	13 (68.4%)	0.232
Yes	11 (50%)	6 (31.6%)
Initiation of feeding
Up to 12 h after surgery	4 (18.2%)	8 (42.1%)	0.247
12 to 24 h after surgery	14 (63.6%)	10 (52.6%)
24 to 48 h after surgery	2 (9.1%)	0 (0)
No data	2 (9.1%)	1 (5.3%)
Comorbidities
Yes	13 (59.1%)	13 (68.4%)	0.536
No	9 (40.9%)	6 (31.6%)
Previous radiotherapy
Yes	3 (13.6%)	1 (5.3%)	0.367
No	19 (86.4%)	18 (94.7%)
Previous surgery
Yes	5 (22.7%)	1 (5.3%)	0.114
No	17 (77.3%)	18 (94.7%)

	Complicated (n = 22)	Noncomplicated (n = 19)	p-Value
%IBW ^a a Percentage of ideal body weight.
>90%	17 (77.3%)	12 (63.2%)	0.517
80%-89%	2 (9.1%)	4 (21.1%)
No data	3 (13.6%)	3 (15.7%)
%WC ^b b Percentage of weight change.
None	6 (27.3%)	5 (26.3%)	0.316
≤5%	2 (9.1%)	6 (31.6%)
5%-10%	9 (40.9%)	5 (26.3%)
≥10%	5 (22.7%)	3 (15.8%)
Type of weight loss
None	6 (27.3%)	5 (26.3%)	0.547
Continuous	11 (50%)	12 (63.1%)
Interspersed with weight recovery periods	5 (22.7%)	2 (10.6%)
Anthropometric data (cm)
Triceps skinfold	1.158 ± 0.48	1.200 ± 0.63	0.811
Arm circumference	26.93 ± 2.73	28.08 ± 3.82	0.269
Calf circumference	29.49 ± 5.70	32.59 ± 5.07	0.341
Body mass index (kg/m²)	23.19 ± 3.74	23.09 ± 3.96	0.934
Bioelectrical impedance
% total body water	51.71 ± 7.85	54.94 ± 3.78	0.1341
% lean body mass	67.38 ± 8.44	70.69 ± 7.02	0.2167
% body fat	31.44 ± 7.89	28.19 ± 6.92	0.2051
Absolute lymphocyte count ^c c (%lymphocytes × leukocytes)/100.
Normal	11 (50%)	6 (31.6%)	0.339
1,200-2,000 mm³	7 (31.8%)	11 (57.9%)
800-1,199 mm³	3 (13.6%)	2 (10.5%)
<800 mm³	1 (4.6%)	0 (0)
Hematological data
Hemoglobin	13.88 ± 1.58	13.95 ± 1.66	0.891
Hematocrit	41.28 ± 4.62	41.38 ± 4.8	0.946
Biochemical data
Total cholesterol	191.9 ± 44.4	182.9 ± 9.613	0.526
HDL	48.15 ± 14.9	48.45 ± 15.23	0.949
LDL	114.15 ± 39.57	112.31 ± 34.57	0.875
Total protein	6.98 ± 0.63	7.04 ± 0.61	0.759

	Complicated (n = 22)	Non-complicated (n = 19)	p-Value
Preoperative albumin	4.11 ± 0.38	4.24 ± 0.42	0.218
First-POD albumin	2.65 ± 0.49	3.04 ± 0.56	0.021
Third-POD albumin	2.85 ± 0.52	3.14 ± 0.51	0.07
Fifth-POD albumin	3.17 ± 0.58	3.40 ± 0.54	0.123
Seventh-POD albumin	3.21 ± 0.63	3.64 ± 0.57	0.027

	Sensitivity	Specificity	LR+^a a LR+, positive likelihood ratio.
<2.3 g/dL	22.73	89.47	2.15
<2.5 g/dL	36.36	84.21	2.30
<2.8 g/dL	68.18	73.68	2.59
<3.0 g/dL	77.27	57.89	1.83
<3.5 g/dL	90.91	15.79	1.08

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] Peer Review under the responsibility of Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial.