Introduction: Sarcopenia, or low skeletal muscle mass, has been identified as an independent risk factor for perioperative complications in head and neck cancer patients. A systematic review was conducted to establish the correlation between sarcopenia and adverse outcome in this group. Methodology: Pubmed, EMBASE and Cochrane search was conducted regarding the effects of pre-operative sarcopenia on HNC patients. The clinical endpoints evaluated include delayed healing, flap loss, delirium, pneumonia, thromboembolic events, survival rate and length of hospital stay. Result: 12 studies met the inclusion criteria and a total of 2182 patients were included. 877 patients met the definition of pre-operative sarcopenia. Sarcopenia increases the overall rates of post-op complications (p<0.0001), flap specific complications (p<0.01) and surgical site infection (p=0.005). Post-operatively, sarcopenic patient had higher rates of pneumonia (p=0.002), delirium (p<0.01), transfusion rate (p<0.001), venous thromboembolism (p<0.01) and time in ICU (p<0.05). Overall 2, 5 and 10 year survival is reduced by 16.6%, 30% and 45% (p=0.03) respectively in the pre-operative sarcopenia population. Notably, pre-operative sarcopenia patients in this population increase the total cost of treatment by 13.49%. Despite heterogeneity between studies, all demonstrated significant correlation between sarcopenia and perioperative complications in head and neck reconstructive patients. Conclusion Sarcopenia increases postoperative complications in head and neck patients and decreases overall survival rate. Sarcopenia is a risk stratification tool that can be used preoperatively to guide surgical decisions.