Does age or frailty have more predictive effect on outcomes following pedicled flap reconstruction? An analysis of 44,986 cases<sup>†</sup>

Cuccolo, Nicholas G.; Sparenberg, Sebastian; Ibrahim, Ahmed M. S.; Crystal, Dustin T.; Blankensteijn, Louise L.; Lin, Samuel J.

doi:10.1080/2000656x.2019.1688166

Cited by 32 publications

(52 citation statements)

References 51 publications

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“…Similar positive associations between age and certain surgical outcomes have been reported in the head and neck literature, [24][25][26] while others have observed a lack of influence. 27,28 Furthermore, we attribute that the longer operation time may suggest more aggressive surgical approaches in the younger patients. These warrant further investigation of age as a risk factor in HD surgery, and caution when managing the elderly.…”

Section: Discussionmentioning

confidence: 97%

Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

Goshtasbi

Verma

2020

Ann Otol Rhinol Laryngol

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Objective: To describe rates of short-term morbidity following transcervical surgical treatment of hypopharyngeal diverticulum (HD) and analyze predictors of adverse events. Methods: The 2005 to 2017 National Surgical Quality Improvement Program database was queried to identify patients diagnosed with HD undergoing open transcervical diverticulectomy. Results: A total of 597 patients with a mean age of 71.4 ± 12.3 years were included. Thirty-day adverse events were experienced by 63 (10.6%) subjects, including 6.5% unplanned reoperations, 4.2% surgical complications, 4.4% medical complications, 2.7% readmissions, and 0.7% deaths. Medical complications notably included pneumonia (2.0%), reintubation (1.2%), sepsis (1.2%), intubation >48 hours (0.5%), urinary tract infection (0.5%), or deep vein thrombosis (0.5%), while surgical complications included organ/space infection (2.0%) and superficial (1.3%) or deep (1.0%) surgical site infection. Gender, race, functional status, diabetes, dyspnea, hypertension, steroid use, and recent weight loss were not associated with adverse events. Length of operation and hospitalization were both higher among those with adverse events (127.4 ± 107.9 vs 95.7 ± 59.8 minutes, P = 0.027, and 7.4 ± 7.4 vs 2.8 ± 3.6 days, P < 0.001). On multivariable logistic regression, high American Society of Anesthesiologists (ASA) class (OR = 2.02, P = 0.017), smoking (OR = 2.10, P = 0.044), and operation time (OR = 1.01; P = 0.005) were independent predictors of adverse events. Obesity was not associated with length of stay, readmission/reoperation, or complications. However, increased age was associated with shorter operations ( P = 0.020), higher length of hospitalization ( P < 0.001), and higher mortality ( P = 0.027) and readmission rates ( P = 0.023). Conclusion: Understanding clinical factors associated with complications following open surgery for HD such as ASA score, smoking status, length of operation, and age can help optimize surgical outcomes for at-risk patients. Level of Evidence: NA

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Section: Discussionmentioning

confidence: 97%

Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

Goshtasbi

Verma

2020

Ann Otol Rhinol Laryngol

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“…With the continuous increase in average life expectancy in the US and across the world, 28 a progressively aging population may be considered for VS surgery and the influence of this variable on surgical outcomes must thus be carefully evaluated. Advanced age has been shown to be associated with higher incidence of postoperative complications in pedicled flap reconstruction, 14 abdominal aortic aneurysm repair, 17 and open anterior skull base surgery. 29 Conversely, increased patient age may not cause adverse events in free-flap head and neck reconstruction 30 and digital revascularization and replantation.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13] Similarly, there have been mixed findings regarding the influence of advanced age on experiencing complications. [14][15][16][17] It is also possible that frailty, defined as the decline in physiological reserve and function across multiple organs, can influence mortality and morbidity following head and neck surgery. 14,18 The influence of these factors as they relate to short-term morbidity following VS resection have not yet been investigated through a large national database.…”

Section: Introductionmentioning

confidence: 99%

“…[14][15][16][17] It is also possible that frailty, defined as the decline in physiological reserve and function across multiple organs, can influence mortality and morbidity following head and neck surgery. 14,18 The influence of these factors as they relate to short-term morbidity following VS resection have not yet been investigated through a large national database. Herein, we summarize our findings on the influence of BMI, age, and frailty on VS surgical outcomes in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.…”

Section: Introductionmentioning

confidence: 99%

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The association of age, body mass index, and frailty with vestibular schwannoma surgical morbidity

Goshtasbi

Abouzari

Soltanzadeh-Zarandi

et al. 2020

Clinical Neurology and Neurosurgery

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Objective: To evaluate whether increased body mass index (BMI), age, or frailty influence vestibular schwannoma (VS) short-term surgical morbidity. Methods:The 2005-2017 National Surgical Quality Improvement Program database was queried for patients with VS undergoing surgical resection. Age was stratified according to age <50, 50-64, and ≥65, while BMI was stratified based on a threshold of 30. Frailty score (0-5) was indicated based on functional status, diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension.Results: A total of 1405 patients were included consisting of 56.7% females with a mean age of 50.7±13.8 years and mean BMI of 29.4±6.6. Patients <50 (n=604), 50-64 (n=578), and ≥65 (n=223), had different duration of surgery (428±173 vs. 392±149 vs. 387±154 minutes; p<0.001) and 30-day mortality rates (0.7% vs. 0% vs. 1.8%; p=0.01). However, post-operative length of stay (LOS) (p=0.16), readmission (p=0.08), reoperation (p=0.54), and complication rates were similar. Post-operative myocardial infarction (p=0.03) and wound infection (p=0.02) were more commonly observed in the obese cohort (BMI≥30) but readmission (p=0.18), reoperation (p=0.44), and complication rates were similar to those with BMI<30. Severely obese patients (BMI≥35) also had higher rates of deep vein thrombosis (p=0.004). Frailty score 0 (n=921), 1 (n=375), and 2-4

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“…Cuccolo et al examined patient frailty versus age on outcomes following pedicled flap reconstruction, including for breast cancer. Although increased age was associated with increased risk of complications, the 5-factor modified frailty index (mFI-5) held much stronger predictive capacity (22).…”

Section: Elderlymentioning

confidence: 99%

Breast reconstruction in the high-risk population: current review of the literature and practice guidelines

Roubaud¹,

Carey²,

Vartanian³

et al. 2021

Gland Surg

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Breast reconstruction is an important part of the cancer treatment paradigm and the psychosocial benefits are well described in the literature. Notably, breast reconstruction restores both the functional and emotional losses patients experience due to tumor resection. Post-cancer quality of life is an important benchmark of successful treatment; therefore, breast reconstruction is an essential component that should be offered whenever possible. Over time, reconstructive techniques and outcomes have improved dramatically resulting in better patient safety and decreased operative morbidity. When counseling a patient for surgery, the provider must consider all aspects of a patient's health. Ideally, breast cancer patients should be physically, emotionally, and oncologically appropriate candidates for reconstruction. However, in concerted effort to provide opportunities for as many patients as possible, the definition of who is a good candidate for reconstruction has evolved to include higher risk patients. These patients include those with advanced age, nicotine use, obesity, and significant ptosis. With improvements in surgical procedures and perioperative care, this population may also benefit from restorative surgery. However, the exact risk of complications and necessary counseling has gone largely undefined in this population. This article examines particular "highrisk" groups that may be challenging for extirpative and reconstructive surgeons and offers current guidelines for practice.

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Does age or frailty have more predictive effect on outcomes following pedicled flap reconstruction? An analysis of 44,986 cases^†

Cited by 32 publications

References 51 publications

Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

The association of age, body mass index, and frailty with vestibular schwannoma surgical morbidity

Breast reconstruction in the high-risk population: current review of the literature and practice guidelines

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Does age or frailty have more predictive effect on outcomes following pedicled flap reconstruction? An analysis of 44,986 cases†

Cited by 32 publications

References 51 publications

Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

The association of age, body mass index, and frailty with vestibular schwannoma surgical morbidity

Breast reconstruction in the high-risk population: current review of the literature and practice guidelines

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Does age or frailty have more predictive effect on outcomes following pedicled flap reconstruction? An analysis of 44,986 cases^†