Nutritional and inflammatory biomarkers as predictors of prolonged hospital stay after surgery for oral cavity squamous cell carcinoma.

BACKGROUND

Length of hospital stay (LOS) after surgery for oral cavity squamous cell carcinoma (OCSCC) reflects both surgical complexity and host status. Whether routine nutritional and inflammatory biomarkers can identify patients at risk of prolonged stay has not been clearly established.

METHODS

Single-centre retrospective cohort study of 168 patients who underwent primary curative-intent surgery for OCSCC between 2015 and 2021. Length of stay was dichotomised at the 75th percentile (≥23 days). Inflammatory and nutritional parameters (NLR, LMR, PLR, Prognostic Nutritional Index [PNI], serum albumin, fibrinogen) were measured at three perioperative timepoints. Associations were evaluated using ROC analysis with Youden's index, multivariable logistic regression, and Kaplan-Meier time-to-discharge.

RESULTS

Median LOS was 16.5 days (IQR 11-23); prolonged stay occurred in 46 patients (27.4%). Optimal cutoffs were PNI <35.8 (AUC 0.654) and postoperative fibrinogen ≥553 mg/dL (AUC 0.620). In multivariable analysis adjusted for age, sex, T and N stage, reconstructive modality, smoking, diabetes and cardiovascular comorbidity, low PNI on the day of surgery was the only independent predictor of prolonged stay (OR 2.87, 95% CI 1.19-6.91; p = 0.019; model AUC 0.772). Kaplan-Meier curves confirmed significantly longer admissions in patients with low PNI or elevated postoperative fibrinogen (log-rank p < 0.001 for both). The discriminatory capacity of biomarkers was concentrated in patients managed without free flap reconstruction (AUC 0.71-0.74), whereas in microsurgical patients hospital stay was governed by post-flap monitoring protocols.

CONCLUSIONS

Day-of-surgery PNI and postoperative fibrinogen identify patients with OCSCC at increased risk of prolonged hospital stay. Their predictive value is most relevant in non-microsurgical patients, in whom proactive nutritional optimisation could shorten admission.