(A560) Impact of pre-operative nutrition and metabolic equivalent of task on outcomes in free flap reconstruction

Monday, October 13, 2025

12:00 PM - 1:00 PM EDT

Location: OTO EXPO, Posters

Presenting Author(s)

SF

Samantha Fabian, MD

Resident
Atrium Health Wake Forest Baptist
Winston-Salem, North Carolina, United States

Author(s)

Zoe-Ann V. Robertson, MD

Resident
Atrium Health Wake Forest Baptist Medical Center
Kernersville, North Carolina, United States
NW

Noah Weinstein

Medical Student
Wake Forest School of Medicine
Winston Salem, North Carolina, United States
KF

Kenneth Feehs, MD

Wake Forest School of Medicine, United States
Mary F. Dover

Medical Student
Wake Forest University School of Medicine
Winston-Salem, North Carolina, United States
Samuel B. Craig, BS

Medical Student
Wake Forest University School of Medicine
Winston-Salem, North Carolina, United States
LG

Lilian D. Galarza Paez, n/a

Medical Student
Wake Forest University School of Medicine
Winston Salem, North Carolina, United States
JB

J. Dale Dale Browne, MD

Chair, Professor
Wake Forest University School of Medicine
Winston Salem, NC, United States
HP

Hafiz S. Patwa, MD

Academic Faculty Physician, ENT/Head and Neck Surgery, Head and Neck Oncology
Wake Forest University
winston Salem, NC, United States
CS

Christopher A. Sullivan, MD

Wake Forest University School of Medicine, United States

Presenting Author(s)

JW

Joshua D. Waltonen, MD

Associate Professor
Wake Forest University School of Medicine
Winston-Salem, North Carolina, United States

Senior Author(s)

AS

Allison A. Slijepcevic, MD

Assistant Professor, Otolaryngology
Atrium Wake Forest Baptist Medical Center, United States

Disclosure(s):

Samantha Fabian, MD: No relevant relationships to disclose.

Zoe-Ann V. Robertson, MD: No relevant relationships to disclose.

Noah Weinstein: No relevant relationships to disclose.

Mary F. Dover: No relevant relationships to disclose.

Samuel B. Craig, BS: No relevant relationships to disclose.

Introduction: Preoperative metabolic equivalent of task (MET) score is considered to play a significant role in surgical recovery. Head and neck cancer and trauma patients who require free flap reconstruction often have concurrent risk factors that may contribute to prolonged healing and length of stay. Therefore, preoperative functional (METS) and nutritional markers were examined to identify modifiable risk factors for improved clinical outcomes.

Methods: Retrospective chart review evaluated adult patients with head and neck defects who underwent reconstruction with a parascapular or scapular free flap from 2012-2020. Statistical analysis (t-test) was used to identify factors associated with postoperative complications and increased length of stay.

Results: 266 patients included. Male: 173/266 (65%). Average age: 64 years. Flap reconstruction: parascapular flaps 185/266 (70%), scapula flaps 81/266 (30%). Average body mass index (BMI): 24.4. Peri-operative albumin: low 48/179 (27%), normal 130/179 (73%). Peri-operative thyroid stimulating hormone (TSH): normal 67/142 (47%), high 71/142 (50%). Average METS: 4.89. Flap outcomes: 237/266 (89%) survived, 16/266 (6%) salvaged, 11/266 (4%) failed. Post-operative reconstructive complications: wound dehiscence 62/266 (23%), fistula 49/266 (18%), surgical site infections 41/266 (15%), and partial flap necrosis 33/266 (12%). Pre-operative nutritional status as measured through BMI, albumin, and TSH did not have a significant influence on post operative complications or length of stay. Length of stay was significantly decreased in patients with an average METS >10 (p value < 0.05).

Conclusions: Average preoperative METS score >10 predicted decreased length of stay in patients undergoing free flap reconstruction after cancer ablation or trauma. Nutritional status did not influence surgical complications or length of stay.