Age and Comorbidities Impact Medical Complications and Mortality Following Free Flap Reconstruction.

Autor: Sweeny, Larissa, Curry, Joseph M., Crawley, Meghan B., DiLeo, Michael, Bonaventure, Caroline A., Luginbuhl, Adam J., Guice, Kelsie M., Taghizadeh, Farshid, McCreary, Eleanor, Buncke, Michelle, Petrisor, Daniel, Wax, Mark K.
Zdroj: Laryngoscope; Apr2022, Vol. 132 Issue 4, p772-780, 9p
Abstrakt: 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 (<65, 65–75, 75–85, and >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: <65 (3.9%), 65 to 75 (4.8%), 75 to 85 (7.1%), and >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: <65 (0.4%), 65 to 75 (0.8%), 75 to 85 (1.1%), and >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. Level of Evidence: 4 Laryngoscope, 132:772–780, 2022 [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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