The impact of advancing age on postoperative outcomes in plastic surgery

Shih, Kevin; Oliveira, Gildàsio S. De; Qin, Charles; Kim, John Y.

doi:10.1016/j.bjps.2015.07.015

Cited by 9 publications

(6 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11,12,14,44 Collected data also showed no statistical difference in medical complications between elderly and very old patients in contrary to a recent database analysis, which showed that medical complications and mortality are more common in patients with age older than 80 years. 45 The review of the total flap loss showed no significant difference between the two age cohorts (6.3 and 5.1%, respectively) as both are comparable to the literature. 12,29,39…”

Section: Discussionsupporting

confidence: 65%

Geriatric Patients with Free Flap Reconstruction: A Comparative Clinical Analysis of 256 Cases

Wähmann

Henn

et al. 2019

J reconstr Microsurg

View full text Add to dashboard Cite

Background In elderly patients, complex soft tissue defects are increasingly observed due to the prolonged life expectancy and accompanying comorbidities. The aim of this study is to evaluate whether free tissue transfer is safe in very old patients without additional risk and complications. Methods All patients older than 65 years undergoing free tissue transfer between November 2007 and September 2016 were reviewed in a retrospective study. Two cohorts were compared regarding perioperative morbidity and postoperative outcome (cohort 1 [old patients, ages 65–79]; cohort 2 [very old patients, ages ≥ 80]). Results In total, 256 patients were included in the study (cohort 1 [n = 217]; cohort 2 [n = 39]). Overall, 262 free flaps were performed due to a second microsurgical reconstruction in six cases. No statistically significant differences between cohorts were observed regarding surgical complications, total flap losses, and mortality. Detailed evaluation of cohort 2 revealed a significant learning curve during the observation period regarding the perioperative management and procedure of soft tissue reconstruction: operation length as well as postoperative intensive care unit stay decreased significantly over time (p < 0.05) and also surgical complications showed a positive trend (p = 0.07). We ascertained a shift toward a “more reliable” flap selection from predominantly anterolateral thigh flap) to axial flaps such as rectus abdominis and latissimus dorsi flaps. Conclusion Our study showed that age is not associated with an increased risk of postoperative complications. Reliable muscle free flaps, two-stage procedures, and safe vascular supply are important strategic aspects to achieve microvascular tissue transfer with high success rates in geriatric patients.

show abstract

Section: Discussionsupporting

confidence: 65%

Geriatric Patients with Free Flap Reconstruction: A Comparative Clinical Analysis of 256 Cases

Wähmann

Henn

et al. 2019

J reconstr Microsurg

View full text Add to dashboard Cite

show abstract

“…The ASA PS classification is associated with significant inter‐observer variability and is influenced by staff characteristics as well as the complexity of diseases, leading to a lack of consistency . Age has not been shown to be independently associated with worse outcomes in patients undergoing surgery, unless accompanied with frailty . The markers of frailty, however, were not assessed in our study as they are not part of the ACS NSQIP® database.…”

Section: Discussionmentioning

confidence: 96%

Post‐operative intensive care unit admission after elective non‐cardiac surgery: A single‐center analysis of the NSQIP database

Bruceta

Souza

Carr

et al. 2019

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Background: Admission to the intensive care unit (ICU) after surgery can be associated with significant morbidity and mortality. This observational cohort study aims to identify perioperative factors associated with post-operative ICU admission in patients undergoing elective non-cardiac surgery.Methods: Data from the ACS NSQIP ® database at a tertiary care academic medical center were analyzed from January 2011 to September 2016. Univariable and multivariable logistic regression of patient and surgery-specific characteristics was performed to assess association with post-operative ICU admission. The Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9) billing codes, as well as associated outcomes, were reviewed. Results:Of 5254 database patient records, 1150 met our inclusion criteria. Elevated body mass index (BMI), longer procedure duration and a diagnosis of disseminated cancer were associated with post-operative ICU admission. Prostatectomy and morbid obesity were the most common CPT and ICD-9 codes identified. Patients who were admitted to the ICU after surgery had a longer hospital length of stay (LOS), had a higher frequency of readmission, re-operation, and in-hospital mortality.Conclusion: Admission to the ICU after elective non-cardiac surgery is common. Our analysis of the ACS NSQIP ® database identified elevated BMI, longer duration of surgery and disseminated cancer as predictors of post-operative ICU admissions in patients undergoing elective non-cardiac surgery.

show abstract

“…Microvascular reconstruction is the gold standard for many forms of head and neck reconstruction (Hanasono et al, ; Kakarala et al, ), but in older patients the impact of age on extirpative, reconstructive, aesthetic, and wound healing outcomes has remained a controversial area with competing opinions (Antony, McCarthy, Disa, & Mehrara, ; Fischer, Nelson, Serletti, & Wu, ; Shih, De Oliveira, Qin, & Kim, ). Head and neck ablative surgery with microvascular reconstruction is a challenging operation and postoperative recovery in an often already medically‐compromised patient population.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

Background: Microvascular reconstruction is the standard of care in head and neck reconstruction, though its perioperative safety in an older population has been controversial due to safety concerns, warranting further investigation. Materials and methods: An"older" (≥71 years) cohort undergoing reconstruction after mandibulectomy/glossectomy was compared to the remaining population in a National Surgical Quality Improvement Program (2008-2016) analysis. Cases required both a mandibulectomy/glossectomy and microvascular or local flap reconstruction (exclusion criteria: missing ages and simultaneous microvascular and local flap reconstruction). Demographics, comorbidities, and procedure types were analyzed on 985 patients (236 [24.4%] were ≥71). Outcomes were compared by reconstruction type. Regressions were performed calculating the impact of age on length of hospital stay (LOHS) and operative time.Results: Ablative procedures were comparable, but older patients received local flaps at higher rates (22.5% vs. 9.6%; p < .001). The older population had more comorbidities (higher ASA class [p < .001], diabetes [p < .001], and hypertension [p < .001]). After Bonferroni correction, univariate subgroup analyses of soft tissue and bone/composite microvascular flaps revealed similar outcomes (except increased medical complications in the older cohort undergoing a bone free flap [p = .002]). Controlling for a variety of factors, older age resulted in longer LOHS (B: 1.4 days; 95% CI: 0.1-2.8 days; p = .035), but not operative time (B: −21.90 min; 95% CI: −52.76 to 8.96 min; p = .164).Conclusion: While increased age (≥70 years) was associated with a longer LOHS, complication rates were comparable. Although limited by the retrospective nature, evidence supports microvascular reconstruction in the elderly population with comparable outcomes.

show abstract

The impact of advancing age on postoperative outcomes in plastic surgery

Cited by 9 publications

References 20 publications

Geriatric Patients with Free Flap Reconstruction: A Comparative Clinical Analysis of 256 Cases

Geriatric Patients with Free Flap Reconstruction: A Comparative Clinical Analysis of 256 Cases

Post‐operative intensive care unit admission after elective non‐cardiac surgery: A single‐center analysis of the NSQIP database

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

Contact Info

Product

Resources

About