Head and neck reconstruction in the elderly patient: a safe procedure?
Demographic changes strongly affect industrialized countries. While free tissue transfer was initially believed to be beneficial only for younger patients, there is an increasing number of elderly patients requiring microvascular operations in our aging society. Medical and surgical risks for head and neck cancer patients over a certain age who undergo free tissue transfer has hardly been investigated. A retrospective mono-center cohort study was performed. All patients with the age 75 or higher undergoing microvascular operations were reviewed. Patient characteristics including the ASA-status, the ACE-27-score, flap survival and postoperative medical and surgical complications were evaluated. The Clavien-Dindo-classification system for postoperative complications was applied to assess the severity of the complications. A total of 31 patients with an average age of 78.8 years were included. 4 patients suffered from venous congestion and had to undergo revision surgery. All flaps could successfully be salvaged. Higher ASA-status and ACE-score were significantly associated with postoperative medical and surgical complications and a higher severity of the complications. However , neither age nor operating time had influence on the complication rate. Microvascular free tissue transfer can be performed with a high degree of security in selected elderly patients. However, serious medical complications remain a concern, correlating strongly with high ASA and ACE-score. Careful patient selection is mandatory to reduce complications to a minimum.
['Reiter|Maximilian|M|', 'Baumeister|Philipp|P|', 'Jacobi|Christian|C|']
D000368:Aged D000369:Aged, 80 and over D005260:Female D005858:Germany D006258:Head and Neck Neoplasms D006801:Humans D008297:Male D055806:Microvessels D061646:Operative Time D010043:Outcome and Process Assessment, Health Care D018579:Patient Selection D011183:Postoperative Complications D019651:Reconstructive Surgical Procedures D012086:Reoperation D012189:Retrospective Studies D013524:Surgical Flaps
Head and neck Reconstruction Elderly Microvascular Complications Free flap Radical