Additional study is warranted to identify the pathophysiologic mechanisms behind the link between preoperative and postoperative hyponatremia and perioperative morbidity in patients with head and neck squamous cell carcinoma (HNSCC), according to an article published online ahead of print in Head & Neck.1

Recent studies suggest that hyponatremia is associated with perioperative morbidity and mortality following surgical procedures in patients with HNSCC. In a retrospective review, researchers investigated the association of hyponatremia with perioperative complications in patients undergoing surgical resection of HNSCC.

A total of 214 patients (age 22 to 100) with pathologically confirmed HNSCC undergoing primary or salvage surgical resection between March 1, 2013 and May 31, 2014 were included in the review.

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Primary tumor sites were oral cavity (47.7%), oropharynx (18.7%), larynx (12.6%), salivary glands (7.9%), cutaneous (7.5%), sinonasal (2.8%), and hypopharynx (2.3%). Surgical resections were balanced between primary (48.1%) and salvage (51.9%). 

Results showed that 7% of patients had preoperative hyponatremia, and 24.9% of patients had postoperative hyponatremia.

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Although no difference in mortality was noted, complications occurred in 27.1% of patients and were more frequent in those with hyponatremia, both preoperative and postoperative (60.0% and 41.3%, respectively). 

Binomial logistic regression demonstrated risk of complications significantly associated with preoperative hyponatremia (odds ratio [OR] = 4.374; 95% CI=1.231-15.545; P=0.023), increasing age (OR = 1.385; 95% CI=1.032-1.857; P=0.030), and increasing length of surgery (OR = 1.234; 95% CI=1.046-1.455; P=0.013). Postoperative hyponatremia was associated with increased hospital length of stay (P=0.034).


  1. Feinstein AJ, Davis J, Gonzalez L et al. Hyponatremia and perioperative complications in patients with head and neck squamous cell carcinoma. [published online ahead of print September 18, 2015]. Head Neck. doi: 10.1002/hed.24229.