Microvascular tissue transfers in the elderly: safety analysis for a challenging area

Abstract

Background/Aim: Due to increased average life expectancy, the number of elderly patients requiring complex reconstructive microsurgical procedures is rising. Age, comorbid conditions, and location of operation are all possible risk factors. The aim of this study is to evaluate surgical outcomes to set the right criteria.Materials and methods: Between 1996 and 2014, the data of 30 patients over the age of 70, who were treated with microsurgical techniques in our clinic, were extracted from patient records and analyzed retrospectively. Results:In this patient population, flap success rate was 94%. Systemic and surgical complication rates were 40% and 48%, respectively. Complication rates were higher in head and neck cases but there was no statistically significant difference compared to reconstructions in other areas. Loss of oral lining, as a serious complication, had no effect on complications in head and neck reconstruction patients in our series.Conclusions: Flap success is comparable to younger age groups but procedures are associated with a high rate of complications Evaluating and controlling comorbid conditions is important. The American Society of Anesthesiologists scoring system is reliable in this patient population. Although complications are more common, these procedures can be performed safely in elderly populations with careful patient selection.

Microvascular reconstruction of head and neck defects in the elderly

“…Both cohorts were similar in regard to gender and clinical profile. Patients in the elderly subgroup had significantly higher ASA and CCI, which is frequently observed in other studies 7,8 . When compared by ablative site, younger patients were statistically more likely to have mucosal ablation and reconstruction with tracheostomy, while elderly patients were more likely to undergo cutaneous primary ablation (Table 1).…”

“…Patients in the elderly subgroup had significantly higher ASA and CCI, which is frequently observed in other studies. 7,8 When compared by ablative site, younger patients were statistically more likely to have mucosal ablation and reconstruction with tracheostomy, while elderly patients were more likely to undergo cutaneous primary ablation (Table 1). Subgroup analyses by primary location (mucosal, cutaneous) revealed limited effect of age upon overall complication rate in these two groups.…”

“…Concern remains in regards to the association of comorbidity and post‐operative complications 10 . Comorbidity scores such as the American Society of Anesthesiologists (ASA) status 11 and Charlson Comorbidity Index (CCI), 12 have been used by several authors to determine if pre‐operative comorbidity burden is associated with inferior post‐operative outcomes 7,8 . No consensus exists, with limited research available on flap‐specific outcomes, 9 or a clear association between comorbidity, age and incidence of medical complication.…”

“…4 Furthermore, studies have shown that patients aged over 70 are less likely to be offered surgical resection and reconstruction. 5 Despite this, chronological age has not been associated with inferior surgical outcome, 3,[6][7][8][9] with recent research placing emphasis upon comorbidity and physiological age as pre-operative risks instead.…”

Impact of advanced age on microvascular reconstruction of the lower facial third: An American College of Surgeons NSQIP study

“…Patients ages 71–90 were grouped into an “older” cohort, as was done in prior literature (Aksu et al, ; Furnas et al, ; Howard et al, ), though it is important to note that individuals ≥90 years of age are simply coded as 90 in NSQIP to prevent patient identification; as this represents just one patient in our cohort, we were comfortable counting the individual as 90 years of age for our analysis. Cases that included a tracheotomy were identified by CPT codes 31,600, 31,601, 31,603, 31,605, and 31,610.…”