To the Editor I am writing to compliment Fancy et al 1 on their article addressing complications, mortality, and functional decline in patients aged 80 years or older undergoing major head and neck ablation and reconstruction. This article addressed a void in the literature that has a significant effect on perioperative surgical planning and patient and caregiver counseling. In agreement with a growing body of surgical literature, the authors found that the old old are a vulnerable surgical population with more than half having serious postoperative complications: the 90-day mortality and loss of independence rates were 8% and 11%, respectively. They confirmed that age per se was not sufficient to explain these outcomes; rather frailty-a common geriatric syndrome 2 -was associated with a higher risk of complications.Similarly, JAMA Otolaryngology-Head & Neck Surgery deserves recognition for publishing clinical investigations aimed at improving outcomes in those 80 years or older. I do, however, wish to bring to the journal's and its readership's attention the importance of specifically addressing cognitive function and delirium in the geriatric population, perioperatively. Delirium, for example, complicates postoperative recovery in up to 50% of older adults and costs the US health care system well over $164 billion annually. 3 Thus, delirium is as important as any medical complication, and data specifically addressing this risk would go a long way toward the goal of prevention and better counseling the patient and/or caregivers. The article by Fancy et al 1 does not directly address cognitive function/delirium and lacks sufficient detail to determine if postoperative cognitive changes and delirium were considered serious complications-one of the main study outcome measures.Otolaryngology and head and neck surgery have been slow to catch up with other surgical specialties in generating practice-specific data guiding the care of the elderly surgical patient. Badly needed is a set of standards that our investigators can use to guide the design of their geriatric-related studies and journals may employ to help improve the effect of submitted articles. Until that time, I encourage your journal, as well as other leading otolaryngology journals, to include otolaryngologists with geriatric-specific training on their editorial staffs and reviewer pools to help maximize the benefits of wellintentioned research reports that aim to improve quality of care in a growing segment of our population.