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DOI: 10.1055/s-0034-1384664
Head and Neck Free Flap Reconstruction in Patients Older than 80 Years
Publikationsverlauf
14. Februar 2014
17. Mai 2014
Publikationsdatum:
15. Juli 2014 (online)
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Abstract
Background Free tissue transfer is a reliable method for reconstruction of head and neck defects. With the growing number of octogenarians in the population, it is important to understand how these patients respond to these procedures.
Methods Through a retrospective chart review of patients who underwent a free-flap reconstruction from 2000 to 2010 at an academic medical center, 48 patients, aged 80 years and older, were compared with a control group consisting of 97 similar patients, aged younger than 80 years. We compared the intensive care unit (ICU) length of stay, overall hospital stay, and the incidence of perioperative complications between the cohorts.
Results The average length of stay in the ICU was significantly longer for the octogenarian group as compared with the younger group (101 vs. 41 hours, p-value = 0.007). The average length of hospital stay was not significantly different between the two groups (difference = 40 hours, p-value = 0.102). The incidence of perioperative complication was 75% in the octogenarian group and 60% in the younger group (p-value = 0.095). There were two flap failures in the younger group, and none in the octogenarian group. There was a significantly higher rate of death within 30 days in the octogenarian group.
Conclusions Microvascular free tissue transfer is a reliable and safe method of reconstruction of head and neck defects in patients over 80 years of age. Patients should be counseled about the potential risks of increased incidence of medical complications, ICU length of stay, and rate of perioperative death when recommended to undergo free tissue transfer reconstruction.
* Both authors are designated as co-first authors.
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References
- 1 Department of Health & Human Services (Administration on Aging) Projected future growth of the older population. Available at: http://www.aoa.gov/Aging_Statistics/future_growth/future_growth.aspx . Accessed May 15, 2012
- 2 Owens WD, Felts JA, Spitznagel Jr EL. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 1978; 49 (4) 239-243
- 3 Hall WH, Ramachandran R, Narayan S, Jani AB, Vijayakumar S. An electronic application for rapidly calculating Charlson comorbidity score. BMC Cancer 2004; 4: 94
- 4 Howard MA, Cordeiro PG, Disa J , et al. Free tissue transfer in the elderly: incidence of perioperative complications following microsurgical reconstruction of 197 septuagenarians and octogenarians. Plast Reconstr Surg 2005; 116 (6) 1659-1668 , discussion 1669–1671
- 5 Coskunfirat OK, Chen HC, Spanio S, Tang YB. The safety of microvascular free tissue transfer in the elderly population. Plast Reconstr Surg 2005; 115 (3) 771-775
- 6 Chick LR, Walton RL, Reus W, Colen L, Sasmor M. Free flaps in the elderly. Plast Reconstr Surg 1992; 90 (1) 87-94
- 7 McGuirt WF, Davis III SP. Demographic portrayal and outcome analysis of head and neck cancer surgery in the elderly. Arch Otolaryngol Head Neck Surg 1995; 121 (2) 150-154
- 8 Blackwell KE, Azizzadeh B, Ayala C, Rawnsley JD. Octogenarian free flap reconstruction: complications and cost of therapy. Otolaryngol Head Neck Surg 2002; 126 (3) 301-306
- 9 Ozkan O, Ozgentas HE, Islamoglu K, Boztug N, Bigat Z, Dikici MB. Experiences with microsurgical tissue transfers in elderly patients. Microsurgery 2005; 25 (5) 390-395
- 10 Singh B, Cordeiro PG, Santamaria E, Shaha AR, Pfister DG, Shah JP. Factors associated with complications in microvascular reconstruction of head and neck defects. Plast Reconstr Surg 1999; 103 (2) 403-411
- 11 Spyropoulou GA, Jeng SF, Hsieh CH, Tsimponis A, Shih HS. Microsurgical reconstruction for head and neck cancer in elderly patients. J Reconstr Microsurg 2014; 30 (2) 91-96
- 12 Ferrari S, Copelli C, Bianchi B , et al. Free flaps in elderly patients: outcomes and complications in head and neck reconstruction after oncological resection. J Craniomaxillofac Surg 2013; 41 (2) 167-171
- 13 Wester JL, Lindau RH, Wax MK. Efficacy of free flap reconstruction of the head and neck in patients 90 years and older. JAMA Otolaryngol Head Neck Surg 2013; 139 (1) 49-53
- 14 Tarsitano A, Pizzigallo A, Sgarzani R, Oranges CM, Cipriani R, Marchetti C. Head and neck cancer in elderly patients: is microsurgical free-tissue transfer a safe procedure?. Acta Otorhinolaryngol Ital 2012; 32 (6) 371-375
- 15 Shaari CM, Buchbinder D, Costantino PD, Lawson W, Biller HF, Urken ML. Complications of microvascular head and neck surgery in the elderly. Arch Otolaryngol Head Neck Surg 1998; 124 (4) 407-411
- 16 Shestak KC, Jones NF, Wu W, Johnson JT, Myers EN. Effect of advanced age and medical disease on the outcome of microvascular reconstruction for head and neck defects. Head Neck 1992; 14 (1) 14-18
- 17 Verhelle N, Preud'homme L, Dequanter D, Van den Hof B, Heymans O, Vico P. Free flaps in the elderly population. Eur J Plast Surg 2005; 28 (3) 149-151
- 18 Serletti JM, Higgins JP, Moran S, Orlando GS. Factors affecting outcome in free-tissue transfer in the elderly. Plast Reconstr Surg 2000; 106 (1) 66-70
- 19 Tsai CH, Chang KP, Hung SY, Chen WF, Cheng MH, Kao HK. Postoperative morbidity in head and neck cancer ablative surgery followed by microsurgical free tissue transfer in the elderly. Oral Oncol 2012; 48 (9) 811-816
- 20 Weymuller Jr EA, Bhama PK. Quality of life in head and neck cancer patients. Expert Rev Anticancer Ther 2007; 7 (9) 1175-1178
- 21 Carey JN, Watt AJ, Ho O, Zeidler K, Lee GK. Free flap scalp reconstruction in a 91-year-old patient under local-regional anesthesia: case report and review of the literature. J Reconstr Microsurg 2012; 28 (3) 189-193
- 22 Saklad M. Grading of patients for surgical procedures. Anaesthesiology 1941; 2: 281-284
- 23 Boruk M, Chernobilsky B, Rosenfeld RM, Har-El G. Age as a prognostic factor for complications of major head and neck surgery. Arch Otolaryngol Head Neck Surg 2005; 131 (7) 605-609
- 24 Rosenberg AJ, Van Cann EM, van der Bilt A, Koole R, van Es RJ. A prospective study on prognostic factors for free-flap reconstructions of head and neck defects. Int J Oral Maxillofac Surg 2009; 38 (6) 666-670
- 25 Clayman GL, Eicher SA, Sicard MW, Razmpa E, Goepfert H. Surgical outcomes in head and neck cancer patients 80 years of age and older. Head Neck 1998; 20 (3) 216-223
- 26 Malata CM, Cooter RD, Batchelor AG, Simpson KH, Browning FS, Kay SP. Microvascular free-tissue transfers in elderly patients: the leeds experience. Plast Reconstr Surg 1996; 98 (7) 1234-1241
- 27 Farwell DG, Reilly DF, Weymuller Jr EA, Greenberg DL, Staiger TO, Futran NA. Predictors of perioperative complications in head and neck patients. Arch Otolaryngol Head Neck Surg 2002; 128 (5) 505-511