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

Larissa Sweeny, Joseph M. Curry, Meghan B. Crawley, Michael DiLeo, Caroline A. Bonaventure, Adam J. Luginbuhl, Kelsie M. Guice, Farshid Taghizadeh, Eleanor McCreary, Michelle Buncke, Daniel Petrisor, Mark K. Wax

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)772-780
Number of pages9
JournalLaryngoscope
Volume132
Issue number4
DOIs
StatePublished - Apr 2022

Keywords

  • free flap
  • free flap failure
  • head and neck reconstruction
  • outcomes
  • surgical complications

ASJC Scopus subject areas

  • Otorhinolaryngology

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