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Complications of microvascular head and neck surgery in the elderly
C M Shaari1, D Buchbinder, P D Costantino
1Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, NY 10029, USA.
Objectives:
To evaluate the complications of head and neck reconstruction using microvascular free tissue transfers (MFTTs) performed in an elderly population and to determine whether these complications are more common than in a younger population.
Setting:
Tertiary referral center.
Patients And Design:
Retrospective, consecutive chart review of patients older than 70 years who underwent MFTT in the past 5 years (group 1). The complications in this population were compared with those in a second group (group 2) of consecutive patients younger than 70 years who were matched according to the site of the primary tumor.
Main Outcome Measures:
Surgical and medical complications.
Results:
The median age for group 1 was 74 years and for group 2, 55 years. The overall complication rate for group 1 was 48%, compared with 57% for group 2. In group 1, surgical morbidity was less common and medical morbidity was more common than in group 2. Mortality rate was 6% for group 1 and 0% for group 2. The types of complications were similar for both groups. There was no difference in complication rates when complications were classified by site of the defect, patient status determined by American Society of Anesthesiologists classification, or use of preoperative radiation. The overall success rate of MFTT was 100% for group 1 and 94% for group 2.
Conclusions:
Microvascular free tissue transfers for head and neck reconstruction can be safely performed in the elderly. An age older than 70 years does not increase the rate of surgical complications following head and neck reconstruction with MFTT. Medical complications, however, are more common and are equally divided between bronchopulmonary and cardiovascular effects.
Insights
Head and neck reconstruction using microvascular free tissue transfers (MFTTs) is safe in elderly patients over 70. While surgical complications are not increased, medical complications like bronchopulmonary and cardiovascular issues are more common.
Area of Science:
- Reconstructive surgery
- Geriatric medicine
- Oncology
Background:
- Head and neck cancer often requires complex reconstruction.
- Microvascular free tissue transfers (MFTTs) are a common reconstructive method.
- The safety of MFTTs in elderly populations requires evaluation.
Purpose of the Study:
- To assess complications of MFTTs in patients over 70.
- To compare complication rates in elderly versus younger patients undergoing MFTTs.
- To identify specific risks associated with MFTTs in older adults.
Main Methods:
- Retrospective chart review of patients >70 years (group 1) undergoing MFTTs.
- Comparison with a matched cohort of patients <70 years (group 2).
- Analysis of surgical and medical complications, and mortality rates.
Main Results:
- Overall complication rate was 48% in group 1 vs. 57% in group 2.
- Surgical morbidity was lower, but medical morbidity was higher in the elderly group.
- Mortality rate was 6% in group 1 vs. 0% in group 2; MFTT success was 100% in group 1.
Conclusions:
- MFTTs are safe for head and neck reconstruction in patients over 70.
- Age >70 does not increase surgical complication rates.
- Elderly patients experience more medical complications, primarily bronchopulmonary and cardiovascular.