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Factors Affecting Outcomes in Older Patients Undergoing Major Head/Neck Surgery

By: Hillary Ojeda
Posted: Monday, November 18, 2019

According to recent study results published in JAMA Otolaryngology–Head & Neck Surgery, a group of demographic and surgical characteristics appear to be linked to postoperative complications including mortality in patients aged 80 and older who underwent head and neck surgery. Tanya Fancy, MD, of West Virginia University, Morgantown, and colleagues believe their results may prove to be valuable during preoperative discussions with patients regarding surgical risks and quality-of-life outcomes. 

“This large, retrospective cohort study represents a major contribution to the literature by combining the multi-institutional experience of patients 80 years or older undergoing major head and neck surgery, as defined by reconstruction in the form of a free flap or a pedicle flap,” the investigators commented.

A total of 376 patients aged 80 years and older undergoing pedicle or free-flap reconstruction after ablative head and neck surgery were enrolled in this retrospective study. Their surgeries took place between January 1, 2015, and December 31, 2017, at 17 academic centers. Using the American Society of Anesthesiologists classification, Adult Comorbidity Evaluation-27 score, and Modified Frailty Index, preoperative comorbidity and frailty were analyzed. Within 90 days, 30 patients (8%) died, and 193 patients (51%) had 30-day serious complications.

Characteristics such as being 85 years or older (odds ratio [OR] for 90-day mortality = 1.19); a body mass index of less than 25 kg/m2 (OR for 30-day complications = 0.95); high frailty (OR for 30-day complications = 1.72); flap failure (OR for 90-day mortality = 3.56); duration of surgery (OR for 90-day functional decline = 2.94); additional operations (OR for 30-day complications = 5.40); and surgery of the maxilla, oral cavity, or oropharynx (OR for 90-day functional decline = 2.51) were linked with worse outcomes. With these data, the authors created a risk-stratification system for use in preoperative discussions with patients.

Disclosure: The study authors’ disclosure information can be found at jamanetwork.com.



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