Patient Age Correlates with Medical, Not Surgical, Complications Following Free Flap Reconstruction

by Linda Kossoff •

How does age correlate with postoperative morbidity and mortality following head and neck free flap reconstruction? 

BOTTOM LINE 

Following free flap reconstruction, patient age did not correlate with a surgical complication but instead with development of a medical complication, and postoperative medical complications correlated with perioperative mortality. 

BACKGROUND: An increasing percentage of elderly patients are undergoing complex head/neck reconstructive procedures. Given the comorbid conditions associated with the physiologic changes of aging and risks of complications inherent in free flap reconstruction procedures, it is crucial to understand the impact of age and comorbidity on these patients’ postoperative outcomes. 

STUDY DESIGN: Retrospective review of prospectively collected databases. 

SETTING: Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Science Center–New Orleans, New Orleans, La. 

SYNOPSIS: Researchers identified 1,972 patients undergoing free flap reconstruction of a head/neck defect between January 2007 and May 2019. Patients were divided by age: <65, 65-75, 75.01- 85, and >85. Demographics, comorbidities, social history, prior treatment, and surgical indication were recorded. Surgical complications following the reconstructive procedure included surgical site infection (10%), free flap compromise (8%), free flap failure (4%), fistula/ salivary leak (4%), wound dehiscence (7%), and hematoma requiring evacuation (5%). There was no difference in operative duration among the age cohorts and no correlation between age and free flap success rates or occurrence of postoperative surgical complications. Medical complications following the procedure were classified as pulmonary, thromboembolism, cardiac, cerebral vascular accident, sepsis, alcohol withdrawal, and death. The incidence of a medical complication (11% of patients) increased with increasing age: <65 (7%), 65–75 (14%), 75–85 (15%), and >85 (26%). Thirty-day mortality rates increased with age (0.4% for <65 and 4% for >85); correlating complications were pulmonary, cardiac, thromboembolism, cerebral vascular accident, and sepsis. Findings showed that, independent of age, comorbid conditions correlated with postoperative complications, which corresponded with 30-day mortality. Study limitations included retrospective design, lack of long-term follow-up, and variable selected for review. 

CITATION: Sweeny L, Curry JM, Crawley MB, et al. Age and comorbidities impact medical complications and mortality following free flap reconstruction. Laryngoscope. 2022;132:772-780.