Bioelectrical-Impedance-Analysis in the Perioperative Nutritional Assessment and Prediction of Complications in Head-and-Neck Malignancies

Objective: Identification of patients with head-and-neck malignancies who are especially vulnerable to malnutrition is critical for optimizing outcomes. The objectives are; to correlate Bioelectrical-impendence-analysis (BIA) parameters with Subjective-Global-Assessment (SGA) scores, and determine the association of BIA parameters with common perioperative complications in patients undergoing head-and-neck surgery.

Study design: Patients underwent formal SGA scoring and BIA preoperatively in a multidisciplinary allied health clinic.

Settings: This is a cohort study of 61 patients with head-and-neck malignancies who were admitted for elective surgery from 2018 to 2019 in a tertiary hospital in Singapore.

Methods: BIA was performed using the Bodystat Quadscan 4000. Kruskal-Wallis rank sum tests and were performed for associations between SGA and BIA parameters. Wilcoxon rank sum tests and multivariable logistic regression models (Firth's bias reduction method) were performed to evaluate associations between BIA parameters and perioperative complications. Receiver-operating-characteristic (ROC) curves were plotted for determination of optimal cut-off values of phase angle and Wellness marker in detecting malnutrition and perioperative pneumonia using Youden's-Index (YI).

Results: 45 males and 16 females with median age of 62 were included in the study. Significant differences were observed in Wellness Marker (P = .006) and phase angle (P = .008) among patients in the 3 SGA categories. The Wellness Marker (P = .02) was associated with perioperative pneumonia in the univariate analysis. No significant differences were observed for other perioperative complications studied.

Conclusion: BIA shows promise as a preoperative tool, in conjunction with SGA, to detect malnutrition in patients undergoing surgery for head-and-neck malignancies and highlight patients at risk of developing perioperative pneumonia.