Postoperative and 1-Year Functional Outcomes After Free Flap Surgery Among Patients 80 Years or Older. (July 2022)

• Record Type: Journal Article
• Authors: Davis, Kyle P.; Kompelli, Anvesh; Gardner, James Reed; Mohler, Samantha; Gammill, Sarah; King, Deanne; Vural, Emre; Sunde, Jumin; Moreno, Mauricio Alejandro
• Is Part Of: Otolaryngology--head and neck surgery. Volume 167:Number 1(2022)
• Page Start: 41
• Page End: 47
• Publication Date: 2022-07
• Subjects: free flap -- elderly -- functional outcomes -- octogenarian -- head and neck surgery; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/01945998221083592
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: To evaluate the postoperative and 1-year functional outcomes after free flap surgery among patients ≥80 years old. Study Design: Retrospective chart review. Setting: Single tertiary care center. Methods: We conducted a retrospective review of 596 patients who underwent head and neck ablation and reconstruction with free tissue over a 7-year period. Patients ≥80 years of age were included. Results: Fifty patients were ≥80 years old, with an average age of 83.7 years. Ninety-day mortality was 12.0%, and those who died were of older age (87.5 vs 83.1 years, P = .036). Prior radiation therapy (odds ratio, 6.8 [95% CI, 1.1-42.7]) and a Charlson Comorbidity Index ≥3 (odds ratio, 10.0 [95% CI, 1.5-67.0]) were associated with an increased risk of 90-day mortality. Overall 21 (42.0%) patients experienced a 30-day complication; 7 (14.0%) were readmitted within 30 days; and 5 (10.0%) underwent additional flap-related operations. Flap failure occurred in 2 (4.0%) patients. Before surgery, 45 (90%) patients were living independently or within assisted living; among these, 19.5% declined to dependent functional status at 90-day follow-up. At 90 days, 2 (8.3%) of 24 patients remained tracheostomy dependent, and 20 (66.7%) of 30 patients required feeding tube supplementation. Among 42 patients, 36 (85.7%) had unrestricted or modified oral diets at 90 days. Charlson Comorbidity Index ≥2 was associated with an increased risk of 1-year mortality (odds ratio, 5.1 [95% CI, 1.4-18.6]). Conclusion: The potential for functional decline and risk of 90-day mortality should be discussed with patients aged ≥80 years.