Aims
The primary aim was to investigate nutrition and swallowing outcomes in patients undergoing complicated skull base surgery for malignant and non-malignant lesions. The secondary aim was to compare outcomes between those who receive pre-surgical dietitian and speech pathology screening through an established multidisciplinary team meeting (Group A), and those who do not receive this screening (Group B).
Methods
Five-year retrospective cohort study of patients who underwent complicated skull base surgery at RBWH (2018-2022). Nutrition and swallowing outcomes were evaluated at baseline, during admission and up to 3-months post-operatively, including malnutrition risk, nutritional status, weight change, diet prescription and a diagnosis of dysphagia by the speech pathologist.
Results
Forty patients were included (n=11 Group A; n=29 Group B), mean age 57+/-14.9 years and 70% male. Overall, 21% of patients were screened as being at risk of malnutrition. Both groups experienced similar weight loss (approximately 10% at 3-months post-surgery) and dysphagia was equally common in both groups (24% during inpatient admission and 13% at 3-months post-surgery).
Group A patients, versus Group B patients, had higher rates of malnutrition at baseline (14% versus 0%) and at 3-months post-surgery (50% versus 40%). More Group A patients, versus Group B patients, were on a texture modified diet at baseline (27% versus 0%) and at 3-months post-surgery (63% versus 50%). Overall, 18% of patients required post-operative tube feeding, with one patient from Group B still reliant on enteral feeding at 3 months post-surgery. A study limitation was the small sample size in Group A and a higher prevalence of missing data in Group B.
Conclusions
All patients undergoing complicated skull base surgery are at risk of developing malnutrition and dysphagia. This research highlights the need for multidisciplinary allied health support and the development of evidence-based guidelines to ensure patients receive necessary care.