Impact of Body Mass Index on Surgical Outcomes in Oncologic Microvascular Head and Neck Reconstruction

Background Despite increasing recognition, obesity continues to represent a major health issue for millions of people in the USA and worldwide. There is a paucity in the literature regarding the effect of body mass index (BMI) on microsurgical head and neck reconstruction. The present study hypothesized that high BMI is predictive of postoperative recipient- and donor-site complications with longer operative times. Patients and Methods Retrospective review of patients who underwent free flap surgery for head and neck reconstruction was performed between January 2005 and December 2018. Patients were categorized into four groups based on BMI: < 20 kg/m(2), 20-30 kg/m(2), 30-40 kg/m(2), and >= 40 kg/m(2). Patient characteristics and surgical outcomes were compared between the four groups. Results Overall, 4000 free flap surgeries were included in the present study, performed on 3753 patients, of whom 9.9% had a BMI < 20 kg/m(2), 64.9% had a BMI between 20 and 30 kg/m(2), 21.6% had a BMI between 30 and 40 kg/m(2), and 3.6% had a BMI >= 40 kg/m(2). After adjusting for potential confounders, multivariate analysis showed no association between BMI and any complication, major recipient complications, or total flap loss. However, multivariate linear regression model showed BMI 30-40 kg/m(2) and BMI >= 40 kg/m(2) to be independently associated with longer operative times compared with BMI < 20 kg/m(2). Conclusion Obesity and high BMI increase operative times; however, with meticulous surgical technique and diligent postoperative care, microvascular head and neck reconstructions can be performed safely and reliably in the majority of patients regardless of BMI with similar overall, recipient-site, and donor-site complications.

Automated summary

This study retrospectively analyzed cases of head and neck reconstruction surgery performed between 2005 and 2018. The results showed that high BMI is associated with longer operative times, but with meticulous surgical technique and diligent postoperative care, the majority of patients can undergo this surgery safely and reliably regardless of BMI, with similar rates of complications.