TY - JOUR
T1 - Age and Comorbidities Impact Medical Complications and Mortality Following Free Flap Reconstruction
AU - Sweeny, Larissa
AU - Curry, Joseph M.
AU - Crawley, Meghan B.
AU - DiLeo, Michael
AU - Bonaventure, Caroline A.
AU - Luginbuhl, Adam J.
AU - Guice, Kelsie M.
AU - Taghizadeh, Farshid
AU - McCreary, Eleanor
AU - Buncke, Michelle
AU - Petrisor, Daniel
AU - Wax, Mark K.
N1 - Publisher Copyright:
© 2021 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2022/4
Y1 - 2022/4
N2 - Objective: Determine if age correlated with surgical or medical complications following head and neck free flap reconstruction. Study Design: Retrospective review of prospectively collected databases. Methods: Patients undergoing head and neck free flap reconstruction at three tertiary care institutions were included (n = 1972). Cohorts were based on age (<65, 65–75, 75–85, and >85). Outcomes reviewed operative duration, length of stay, surgical complications (free flap failure, fistula, hematoma, dehiscence, and infection), and medical complications (thromboembolism, stroke, cardiac, and pulmonary). Results: Anatomic site (P <.0001) and donor site varied by age (P <.0001). There was no difference in operative duration (P =.3) or length of hospitalization (P =.8) by age. The incidence of medical complications increased with increasing age. Pulmonary complication rates: <65 (3.9%), 65 to 75 (4.8%), 75 to 85 (7.1%), and >85 (11%) (P =.02). Cardiac complication rates: <65 (2.0%), 65 to 75 (7.3%), 75 to 85 (6.1%), and >85 (16.4%) (P <.0001). Mortality increased with age: <65 (0.4%), 65 to 75 (0.8%), 75 to 85 (1.1%), and >85 (4.1%) (P <.003). Medical complications correlated with mortality rates: pulmonary (3.5% vs. 0.6%; OR: 5.5; 95% CI: 1.5–20.0; P =.004); cardiac (3.3% vs. 0.6%; OR: 6.0; 95% CI: 1.6–21.8; P =.002); thromboembolism (4.6% vs. 0.7%; OR: 7.3; 95% CI: 1.6–33.6; P =.003); stroke (42% vs. 0.5%; OR: 149; 95% CI: 40–558; P <.0001); and sepsis (5% vs. 0.7%; OR 7.5; 95% CI: 1.0–60.5; P =.03). Age did not correlate with free flap success (P =.5), surgical complications (hematoma, P =.33; fistula, P =.23; infection, P =.07; and dehiscence, P =.37), or thirty-day readmission (P =.3). Conclusion: Following free flap reconstruction, patient age did not correlate with development of a surgical complication. Patient age did correlate with development of a medical complication. Postoperative medical complications were found to correlate with perioperative mortality. Level of Evidence: 4 Laryngoscope, 132:772–780, 2022.
AB - Objective: Determine if age correlated with surgical or medical complications following head and neck free flap reconstruction. Study Design: Retrospective review of prospectively collected databases. Methods: Patients undergoing head and neck free flap reconstruction at three tertiary care institutions were included (n = 1972). Cohorts were based on age (<65, 65–75, 75–85, and >85). Outcomes reviewed operative duration, length of stay, surgical complications (free flap failure, fistula, hematoma, dehiscence, and infection), and medical complications (thromboembolism, stroke, cardiac, and pulmonary). Results: Anatomic site (P <.0001) and donor site varied by age (P <.0001). There was no difference in operative duration (P =.3) or length of hospitalization (P =.8) by age. The incidence of medical complications increased with increasing age. Pulmonary complication rates: <65 (3.9%), 65 to 75 (4.8%), 75 to 85 (7.1%), and >85 (11%) (P =.02). Cardiac complication rates: <65 (2.0%), 65 to 75 (7.3%), 75 to 85 (6.1%), and >85 (16.4%) (P <.0001). Mortality increased with age: <65 (0.4%), 65 to 75 (0.8%), 75 to 85 (1.1%), and >85 (4.1%) (P <.003). Medical complications correlated with mortality rates: pulmonary (3.5% vs. 0.6%; OR: 5.5; 95% CI: 1.5–20.0; P =.004); cardiac (3.3% vs. 0.6%; OR: 6.0; 95% CI: 1.6–21.8; P =.002); thromboembolism (4.6% vs. 0.7%; OR: 7.3; 95% CI: 1.6–33.6; P =.003); stroke (42% vs. 0.5%; OR: 149; 95% CI: 40–558; P <.0001); and sepsis (5% vs. 0.7%; OR 7.5; 95% CI: 1.0–60.5; P =.03). Age did not correlate with free flap success (P =.5), surgical complications (hematoma, P =.33; fistula, P =.23; infection, P =.07; and dehiscence, P =.37), or thirty-day readmission (P =.3). Conclusion: Following free flap reconstruction, patient age did not correlate with development of a surgical complication. Patient age did correlate with development of a medical complication. Postoperative medical complications were found to correlate with perioperative mortality. Level of Evidence: 4 Laryngoscope, 132:772–780, 2022.
KW - free flap
KW - free flap failure
KW - head and neck reconstruction
KW - outcomes
KW - surgical complications
UR - http://www.scopus.com/inward/record.url?scp=85113132566&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85113132566&partnerID=8YFLogxK
U2 - 10.1002/lary.29828
DO - 10.1002/lary.29828
M3 - Article
C2 - 34415067
AN - SCOPUS:85113132566
SN - 0023-852X
VL - 132
SP - 772
EP - 780
JO - Laryngoscope
JF - Laryngoscope
IS - 4
ER -