Age and Comorbidities Impact Medical Complications and Mortality Following Free Flap Reconstruction. (20th August 2021) - Sweeny, Larissa
Abstract : 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