title: Utility of a perioperative nutritional intervention on postoperative outcomes in high-risk head & neck cancer patients.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.affiliation: 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.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Rowan
authors.affiliation: 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.
authors.forename: Jonas T
authors.initials: JT
authors.lastname: Johnson
authors.affiliation: 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.
authors.forename: Christina E
authors.initials: CE
authors.lastname: Fratangelo
authors.affiliation: UPMC Montefiore Hospital, Same Day Surgery Services, 3459 Fifth Avenue, Pittsburgh, PA 15213, United States. Electronic address: smithbk@upmc.edu.
authors.forename: Brenda K
authors.initials: BK
authors.lastname: Smith
authors.affiliation: 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.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Kemerer
authors.affiliation: 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.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ferris
mesh_terms: D001120:Arginine / Q000008:administration & dosage*; D004750:Enteral Nutrition / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D019990:Perioperative Care / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D001120:Arginine
keywords: Arginine; Fistula; Head and neck cancer; Healthcare costs; Laryngeal cancer; Length of stay; Nutritional status; Oral cancer; Oropharyngeal cancer; Quality improvement