Malnutrition linked to poor outcomes after surgery for head and neck cancer
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Key takeaways:
- Non-Hispanic Black patients and those insured with Medicaid or Medicare had an increased risk for malnutrition.
- Researchers noted no independent association between malnutrition and mortality.
More than 20% of patients undergoing surgery for head and neck cancer are malnourished, according to data published in JAMA Otolaryngology Head & Neck Surgery.
Non-Hispanic Black patients and patients insured with Medicaid maintained the highest risk for being malnourished before surgery among those evaluated in the anlaysis, which contributed to several inferior treatment outcomes, researchers noted.
“The findings of this retrospective cohort study indicate that malnutrition is unequally distributed among patients, by race and payer status,” William T. Reed, MD, MPH, an ENT-otolaryngologist in the department of head and neck surgery & communication sciences at Duke University Health System, and researchers wrote. “Furthermore, as opposed to malnutrition secondary to other causes or in the general surgical population, patients with [head and neck cancer] face a unique combination of challenges — ie, dysphagia, odynophagia, and treatment related toxic effects associated with chemotherapy, radiation therapy, and surgery.”
Background and methodology
Patients with head and neck cancer are at an increased risk for malnutrition, with little data existing on the extent of outcomes and the sociodemographic factors associated with malnutrition.
Reed and colleagues conducted a retrospective cohort study to investigate the potential association of race, ethnicity and payer type with perioperative malnutrition among patients undergoing surgery for head and neck cancer.
Researchers utilized data from the Premier Healthcare Database to assess 13,895 adults (mean age, 63.4 years; 67.8% male; 77% white) who had undergone surgery for head and neck cancer from January 2008 to June 2020 at 482 hospitals across the United States.
Perioperative malnutrition status served as the primary outcome for comparison to find associations among race, ethnicity, payer type, malnutrition and clinical outcomes, whereas discharge to home after surgery, hospital length of stay, total cost and postoperative pulmonary complications served as secondary outcomes.
Results, next steps
Researchers noted that, among the study population, 3,136 patients (22.6%) received a perioperative malnutrition diagnosis.
When compared with white patients and patients with private health insurance, non-Hispanic Black patients had elevated increased risk for malnutrition (adjusted OR = 1.31; 95% CI, 1.11-1.56), as did patients with Medicaid insurance (adjusted OR = 1.68; 95% CI, 1.46-1.95) and Medicare insurance (adjusted OR = 1.24; 95% CI, 1.1-1.73).
Black patients and patients insured through Medicaid also had increased length of hospital stay, costs and postoperative pulmonary complications, as well as lower rates of discharge to home.
Investigators reported independent associations between malnutrition and increased length of stay (beta = 5.2 additional days; 95% CI, 4.83-5.64), higher costs (beta = $15,722 more cost; 95% CI, $14,301-$17,143), increased odds of postoperative pulmonary complications (adjusted OR = 2.04; 95% CI, 1.83-2.23), and lower odds of discharge to home (adjusted OR = 0.34; 95% CI, 0.31-0.38).
However, researchers observed no independent association between malnutrition and mortality.
Reed and colleagues acknowledged several study limitations, including the fact that the study accounted for one index surgical encounter per patient, thus limiting the potential for a patient to endure multiple malnutrition diagnoses over the course of several weeks or months.
The results highlight a need for approaches to correct disparities among patients undergoing surgery for head and neck cancer, according to the researchers.
“Most importantly, early identification and treatment of malnutrition are vital for all patients, especially those undergoing [head and neck cancer] surgery,” researchers wrote. “We invite further investigation so that clinicians caring for patients with [head and neck cancer] can continue to improve their outcomes.”
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