Postoperative Loss of Independence in Geriatric Head and Neck Cancer Patients: A Database Study

Loss of independence (LOI) is a key concern after head and neck cancer (HNC) surgery, yet its predictors remain unclear. This study aimed to identify perioperative and postoperative factors linked to LOI in geriatric HNC patients.

We conducted a retrospective cohort study using 2021-2023 ACS-NSQIP data. Patients aged ≥ 75 years who underwent HNC surgery with preoperative and discharge functional status data were included. The primary outcome was LOI, defined as a decline in functional status at discharge compared to baseline. Logistic regression was used to identify independent predictors of LOI.

Among 4290 patients, 471 (10.9%) experienced LOI. LOI was associated with diabetes (p = 0.001), metastatic disease (p = 0.037), smoking (p = 0.001), dementia (p < 0.0001), and falling within 6 months (p < 0.0001). Longer operative times (mean 320.89 vs. 63.68 min, p < 0.0001) and hospital stays ≥ 2 days (p < 0.0001) were associated with LOI. Overweight and obese patients had lower odds of LOI (OR: 0.75, 95% CI: [0.57, 0.98]; OR: 0.70, 95% CI: [0.52, 0.95]). Operative time > 5 h (OR: 1.66, 95% CI: [1.1-2.35]) and length of stay ≥ 2 days (OR: 2.13, 95% CI: [1.48-3.07]) were associated with LOI. Surgical procedures linked to higher odds included free flap (OR: 1.89, 95% CI: [1.70-8.39]), laryngeal resection (OR: 3.99, 95% CI: [1.40-11.34]), neck dissection (OR: 2.78, 95% CI: [1.29-5.99]), regional flap (OR: 3.85, 95% CI: [1.80-8.27]), and total glossectomy (OR: 2.65, 95% CI: [1.02-6.86]).

Identifying patients at risk for LOI may guide surgical decision-making in older adults undergoing HNC surgery.