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Utility of a perioperative nutritional intervention on postoperative outcomes in high-risk head & neck cancer patients.
Oral Oncol. 2016 Mar; 54:42-6.OO

Abstract

OBJECTIVES

Investigate both the utility and feasibility of perioperative nutritional supplementation with an arginine-enriched immunonutrition formula to high-risk head and neck cancer surgical patients and examine its effects on acute post-operative clinical outcomes.

MATERIALS & METHODS

This prospective, non-randomized, interventional cohort study compared high-risk head and neck cancer surgical patients who consumed a pre- and post-operative arginine-based nutritional supplement to those that did not. Outcome measures included post-operative complications, length of hospitalization, readmission rates and measurement of nutritional biomarkers.

RESULTS

195 high-risk head and neck cancer surgical patients were enrolled. 59% of the patients used the nutritional supplement, 41% did not. Of the 80 patients who did not receive the immunonutrition formula, 38 (47.5%) experienced post-operative complications of all types as compared to 29 of the 115 (25.2%) patients who did consume the product (p=0.0021). Pharyngeal leaks or fistulas were the most common post-operative complications in both groups and more common in patients who did not receive supplementation (p=0.007). Length of stay was on average 2.8 days longer in patients who did not have enhanced nutrition (p=0.02), while readmission rates between the two groups were similar (p=0.91). Measurements of nutritional biomarkers were not reported secondary to low collection rates.

CONCLUSION

Enhanced perioperative nutrition may result in significant reductions of post-operative fistula formations and decreased length of stay in a high-risk head and neck cancer population, even in the setting of poor compliance. The potential quality improvement in both patient care and healthcare cost is both real and significant.

Authors+Show Affiliations

University of Pittsburgh Medical Center, Department of Otolaryngology Head & Neck Surgery, Eye & Ear Institute, Suite 500, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: rowannr@upmc.edu.University of Pittsburgh Medical Center, Department of Otolaryngology Head & Neck Surgery, Eye & Ear Institute, Suite 500, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: johnsonjt@upmc.edu.University of Pittsburgh Medical Center, Department of Otolaryngology Head & Neck Surgery, Eye & Ear Institute, Suite 500, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: mascce@upmc.edu.UPMC Montefiore Hospital, Same Day Surgery Services, 3459 Fifth Avenue, Pittsburgh, PA 15213, United States. Electronic address: smithbk@upmc.edu.University of Pittsburgh Medical Center, Department of Otolaryngology Head & Neck Surgery, Eye & Ear Institute, Suite 500, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: kemererpa@mail.magee.edu.University of Pittsburgh Medical Center, Department of Otolaryngology Head & Neck Surgery, Eye & Ear Institute, Suite 500, 200 Lothrop St., Pittsburgh, PA 15213, United States. Electronic address: ferrrl@upmc.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26803343

Citation

Rowan, Nicholas R., et al. "Utility of a Perioperative Nutritional Intervention On Postoperative Outcomes in High-risk Head & Neck Cancer Patients." Oral Oncology, vol. 54, 2016, pp. 42-6.
Rowan NR, Johnson JT, Fratangelo CE, et al. Utility of a perioperative nutritional intervention on postoperative outcomes in high-risk head & neck cancer patients. Oral Oncol. 2016;54:42-6.
Rowan, N. R., Johnson, J. T., Fratangelo, C. E., Smith, B. K., Kemerer, P. A., & Ferris, R. L. (2016). Utility of a perioperative nutritional intervention on postoperative outcomes in high-risk head & neck cancer patients. Oral Oncology, 54, 42-6. https://doi.org/10.1016/j.oraloncology.2016.01.006
Rowan NR, et al. Utility of a Perioperative Nutritional Intervention On Postoperative Outcomes in High-risk Head & Neck Cancer Patients. Oral Oncol. 2016;54:42-6. PubMed PMID: 26803343.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utility of a perioperative nutritional intervention on postoperative outcomes in high-risk head & neck cancer patients. AU - Rowan,Nicholas R, AU - Johnson,Jonas T, AU - Fratangelo,Christina E, AU - Smith,Brenda K, AU - Kemerer,Patricia A, AU - Ferris,Robert L, Y1 - 2016/01/21/ PY - 2015/09/04/received PY - 2016/01/07/revised PY - 2016/01/08/accepted PY - 2016/1/25/entrez PY - 2016/1/25/pubmed PY - 2016/12/28/medline KW - Arginine KW - Fistula KW - Head and neck cancer KW - Healthcare costs KW - Laryngeal cancer KW - Length of stay KW - Nutritional status KW - Oral cancer KW - Oropharyngeal cancer KW - Quality improvement SP - 42 EP - 6 JF - Oral oncology JO - Oral Oncol. VL - 54 N2 - OBJECTIVES: Investigate both the utility and feasibility of perioperative nutritional supplementation with an arginine-enriched immunonutrition formula to high-risk head and neck cancer surgical patients and examine its effects on acute post-operative clinical outcomes. MATERIALS & METHODS: This prospective, non-randomized, interventional cohort study compared high-risk head and neck cancer surgical patients who consumed a pre- and post-operative arginine-based nutritional supplement to those that did not. Outcome measures included post-operative complications, length of hospitalization, readmission rates and measurement of nutritional biomarkers. RESULTS: 195 high-risk head and neck cancer surgical patients were enrolled. 59% of the patients used the nutritional supplement, 41% did not. Of the 80 patients who did not receive the immunonutrition formula, 38 (47.5%) experienced post-operative complications of all types as compared to 29 of the 115 (25.2%) patients who did consume the product (p=0.0021). Pharyngeal leaks or fistulas were the most common post-operative complications in both groups and more common in patients who did not receive supplementation (p=0.007). Length of stay was on average 2.8 days longer in patients who did not have enhanced nutrition (p=0.02), while readmission rates between the two groups were similar (p=0.91). Measurements of nutritional biomarkers were not reported secondary to low collection rates. CONCLUSION: Enhanced perioperative nutrition may result in significant reductions of post-operative fistula formations and decreased length of stay in a high-risk head and neck cancer population, even in the setting of poor compliance. The potential quality improvement in both patient care and healthcare cost is both real and significant. SN - 1879-0593 UR - https://www.unboundmedicine.com/medline/citation/26803343/Utility_of_a_perioperative_nutritional_intervention_on_postoperative_outcomes_in_high_risk_head_&_neck_cancer_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1368-8375(16)00009-9 DB - PRIME DP - Unbound Medicine ER -