Microvascular reconstruction of head and neck defects in the elderly

Abstract

Background Microvascular free‐flap reconstruction of the head and neck is a common technique utilized across many ages. The purpose of this study was to identify if advanced age or comorbidity was associated with worse post‐operative outcomes in patients undergoing free‐flap reconstruction. Methods A retrospective analysis was performed on 344 consecutive patients undergoing free‐flap surgery of the head and neck. Demographic, clinical and pathological factors were considered along with Charlson Comorbidity Index (CCI) scores and American Society of Anesthesiologists (ASA) status. Logistic regression analysis was used to investigate the association of age, CCI or ASA with post‐operative complications. Results Elderly patients (≥75 years) had a higher overall complication rate (odds ratio (OR) 1.7, P = 0.04) that was restricted to medical complications (OR 2.1, P = 0.05) and not surgical complications (OR 1.4, P = 0.14). Reconstructions of defects from cutaneous malignancy predominated in the elderly cohort (48% versus 29%, P < 0.01), but there was no difference in complication rate when cutaneous or mucosal subgroups were separated by age. ASA IV status was weakly associated with surgical complications (OR 3.89, P = 0.053), but CCI and elderly age were not associated with any outcome. Median length of stay was similar between age groups. Conclusion Free‐flap reconstruction in older patients was associated with increased medical complications, and surgical complications were weakly associated with ASA status. Advanced age or comorbidity should not preclude microvascular reconstruction, but comorbid status should be optimized pre‐operatively and factors predisposing to medical complications minimized where possible.

How age affects health‐related‐quality‐of‐life outcomes in maxillomandibular reconstructive surgery

“…In a study examining the effect of advanced age on post‐operative outcomes in the, Every et al . found that elderly patients (in this case, those aged above 75 years) had a higher overall complication rate (odds ratio 1.7) that was restricted to medical complications (odds ratio 2.1) and not surgical complications 45 . Other studies have shown similar data, confirming the relationship between elderly patients and postoperative medical complications 15,16 .…”

“…In a study examining the effect of advanced age on post-operative outcomes in the, Every et al found that elderly patients (in this case, those aged above 75 years) had a higher overall complication rate (odds ratio 1.7) that was restricted to medical complications (odds ratio 2.1) and not surgical complications. 45 Other studies have shown similar data, confirming the relationship between elderly patients and postoperative medical complications. 15,16 Islam and Badry's retrospective study on postoperative complications in elderly patients undergoing surgery for HNC treatment also found a significant link between the elderly and medical complications, yet not surgical complications.…”

Designing an evidence‐based free‐flap pathway in head and neck reconstruction

“…Despite high overall free‐flap success rates, complications following head and neck free‐flap reconstruction remain common. Of these, the most common surgical complications include dehiscence, fistula, infection, hematoma, and flap compromise 29,30 . Additionally, intraoperative holdups remain a common cause for delay, adding to operative time, anesthesia time, and OR costs.…”

“…Of these, the most common surgical complications include dehiscence, fistula, infection, hematoma, and flap compromise. 29,30 Additionally, intraoperative holdups remain a common cause for delay, adding to operative time, anesthesia time, and OR costs. Previous authors have estimated average operating room costs to equal $66 per min, which are likely to be even higher in complex surgeries such as head and neck free-flap reconstruction.…”