Age and Comorbidities Impact Medical Complications and Mortality Following Free Flap Reconstruction
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 (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: 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: 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.
Sweeny, Larissa; Curry, Joseph M.; Crawley, Meghan B.; DiLeo, Michael D.; Bonaventure, Caroline A.; Luginbuhl, Adam J.; Guice, Kelsie M.; Taghizadeh, Farshid; McCreary, Eleanor; Buncke, Michelle; Petrisor, Daniel; and Wax, Mark K., "Age and Comorbidities Impact Medical Complications and Mortality Following Free Flap Reconstruction" (2021). School of Medicine Faculty Publications. 1229.