title: Low prealbumin level is a risk factor for microvascular free flap failure.
abstract: OBJECTIVE
  The purposes of this study were 1) to estimate and compare the 1-month survival rates of patients with acute malnutrition (low prealbumin level) and patients who are not malnourished (normal prealbumin level) and 2) to identify risk factors associated with microvascular free flap failure.
  
  
  METHODS
  To address the research purposes, we designed a retrospective cohort study and enrolled a sample composed of patients who underwent head and neck microvascular reconstruction and had prealbumin levels measured in the perioperative period. The primary predictor variable was nutritional status (low vs normal prealbumin level). The primary outcome variable was flap survival. One-month survival rates were estimated by use of Kaplan-Meier survival analyses. Risk factors for free flap failure were identified by use of multivariate marginal Cox proportional hazards modeling.
  
  
  RESULTS
  The sample was composed of 162 patients who underwent microvascular free tissue transfer during the study enrollment period. The 1-month survival estimates for patients who were and were not malnourished were 76.5% (95% confidence interval [CI], 48.8% to 90.5%) and 95.2% (95% CI, 90.1% to 97.7%), respectively (P = .002). In the adjusted Cox hazards proportions model, acute malnutrition was associated with a 4-fold increased risk of failure (P = .04) in comparison with those patients with a normal nutritional status.
  
  
  CONCLUSIONS
  Acute malnutrition in patients undergoing microvascular free flap reconstruction in the head and neck region was associated with an increased risk for free flap failure.
authors.affiliation: Formerly, Fellow, Head and Neck Oncologic and Microvascular Surgery, Providence Cancer Center, Legacy Emanuel Medical Center, Portland, OR. Electronic address: jw.shum@gmail.com.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Shum
authors.affiliation: Resident in Training, Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Markiewicz
authors.affiliation: Fellow, Head and Neck Oncologic and Microvascular Surgery, Providence Cancer Center, Legacy Emanuel Medical Center, Portland, OR.
authors.forename: Etern
authors.initials: E
authors.lastname: Park
authors.affiliation: Attending Surgeon, Head, Neck and Oral Cancer Program, Providence Cancer Center, Portland, OR; and Affiliate Assistant Professor, Oregon Health and Science University, Portland, OR.
authors.forename: Tuan
authors.initials: T
authors.lastname: Bui
authors.affiliation: Attending Surgeon, Head, Neck and Oral Cancer Program, Providence Cancer Center, Portland, OR; and Affiliate Assistant Professor, Oregon Health and Science University, Portland, OR.
authors.forename: Joshua
authors.initials: J
authors.lastname: Lubek
authors.affiliation: Director of Maxillofacial Trauma and Attending Surgeon, Trauma Service and Oral and Maxillofacial Surgery Service, Legacy Emanuel Medical Center, Portland, OR; and Affiliate Professor, Oregon Health and Science University, Head and Neck Surgical Associates, Portland, OR.
authors.forename: R Bryan
authors.initials: RB
authors.lastname: Bell
authors.affiliation: Director of Head and Neck Oncologic Surgery Fellowship and Attending Surgeon, Trauma Service and Oral and Maxillofacial Surgery Service, Legacy Emanuel Medical Center, Portland, OR; and Affiliate Professor, Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dierks
mesh_terms: D000368:Aged; D000428:Alcohol Drinking; D015992:Body Mass Index; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006085:Graft Survival / Q000502:physiology*; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000503:physiopathology; D008875:Middle Aged; D009752:Nutritional Status; D016491:Peripheral Vascular Diseases / Q000150:complications; D011228:Prealbumin / Q000032:analysis*; D016016:Proportional Hazards Models; D011655:Pulmonary Embolism / Q000150:complications; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications
chemical_list: D011228:Prealbumin