Abstract
<title>Abstract</title> <p>Background Postoperative complications after reconstructive surgery for oral cancer can delay recovery and prolong hospitalization. Although sarcopenia and frailty have been associated with adverse surgical outcomes, evidence remains limited regarding whether simple preoperative physical performance tests can stratify the risk of postoperative complications other than isolated surgical site infection. This study aimed to investigate the association between preoperative physical function and non-SSI postoperative complications after oral cancer reconstruction and to develop a simple risk stratification model. Methods This single-center retrospective cohort study included 129 patients who underwent reconstructive surgery for oral cancer and had available preoperative physical function data. Preoperative physical function was assessed 1 or 2 days before surgery using grip strength, single-leg stance time, the five-times sit-to-stand test, Timed Up and Go, gait speed, and 4-minute walking distance. The primary outcome was JCOG Grade ≥ 2 non-SSI postoperative complications, excluding isolated SSI but including systemic and flap-related complications. Univariable and multivariable logistic regression analyses were performed. A risk score was developed using clinically applicable cutoff values for single-leg stance time and Timed Up and Go. Results JCOG Grade ≥ 2 non-SSI postoperative complications occurred in 63 patients, and JCOG Grade ≥ 3 complications occurred in 32 patients. Patients with JCOG Grade ≥ 2 complications had significantly shorter single-leg stance time, longer Timed Up and Go time, and shorter 4-minute walking distance. In multivariable analysis, decreased single-leg stance time remained independently associated with JCOG Grade ≥ 2 complications after adjustment for age, sex, BMI, operative time, intraoperative blood loss, and preoperative chemotherapy. This association was also observed for JCOG Grade ≥ 3 complications. The complication rates according to the risk score were 20.6%, 54.2%, and 63.8% in the 0-, 1-, and 2-point groups, respectively. Conclusions Decreased preoperative single-leg stance time was independently associated with clinically relevant non-SSI postoperative complications after oral cancer reconstruction. A simple risk score combining single-leg stance time and Timed Up and Go may help identify patients at increased risk and support individualized perioperative management.</p>