Outcome predictors in elderly head and neck free flap reconstruction: A retrospective study and systematic review of the current evidence

Goh, Cindy Siaw-Lin; Kok, Yee-Onn; Yong, Cheryl Pei-Chyi; Tan, Esther W.X.; Goh, Lee Gan; Chew, Khong-Yik; Teo, Constance; Goh, Terence

doi:10.1016/j.bjps.2017.12.011

Cited by 47 publications

(50 citation statements)

References 25 publications

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“…Goh et al . investigated outcomes for head and neck malignancy post free flap reconstruction and similarly found that comorbidity, rather than age, predicted post‐operative complications . Our findings agree with these, with the added information that some specific comorbidities have a greater influence on post‐operative outcomes.…”

Section: Discussionsupporting

confidence: 86%

Relationship between age, comorbidities and complications in head and neck cancer patients undergoing curative surgery

Shepherd

Creber

Mansour

et al. 2019

ANZ Journal of Surgery

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Background: Both age and comorbidity are accepted as significant prognostic factors for adverse perioperative outcomes in major surgery. Elderly patients may be overlooked for radical treatment for fear of poor perioperative outcome. We aim to assess the relationship between age, comorbidities and post-operative outcomes in a tertiary head and neck unit. Methods: A retrospective analysis was undertaken on 651 patients who underwent surgery for head and neck cancer at a tertiary hospital between 2007 and 2014. Results: A total of 253 (38.9%) patients were aged ≥70 years and 398 (61.1%) patients were ≤69 years. Age alone did not predict prolonged post-operative stay, perioperative complications nor perioperative mortality. Congestive cardiac failure and/or complicated diabetes were significantly associated with poor outcomes, as was male sex. Conclusion: Patients of any age with cardiac failure or complicated diabetes have a higher rate of post-operative complications in head and neck surgery. © 2019 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 851-855ANZJSurg.com

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Section: Discussionsupporting

confidence: 86%

Relationship between age, comorbidities and complications in head and neck cancer patients undergoing curative surgery

Shepherd

Creber

Mansour

et al. 2019

ANZ Journal of Surgery

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“…This is consistent with a number of other studies, and suggests that rather than age, the decision about whether to pursue microvascular head and neck reconstruction should depend on medical comorbidities (Chang et al, ; Ferrari et al, ; Goh et al, ; Patel et al, ; Piazza et al, ; Sugiura et al, ). Medical comorbidities remain the strongest predictor for complications and prolonged hospital length of stay.…”

Section: Discussionsupporting

confidence: 85%

“…Current practice patterns from this study suggest that surgeons may already be choosing the reconstruction type based on the patient's overall health status. Among patients who received microvascular reconstruction, there were no differences in proportion of higher ASA class patients between the older cohort and the remaining population (Ferrari et al, ; Goh et al, ; Piazza et al, ; Sugiura et al, ). Because older patients had on average a higher number of baseline comorbidities, they may be less likely to receive microvascular reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…While some have advocated microvascular reconstruction in the older population, no large, multi‐institutional, adequately powered study has been performed before this one (Bhama, Patel, Khan, Bhrany, & Futran, ; Ferrari et al, ; Goh et al, ; Patel et al, ; Piazza et al, ; Sugiura et al, ). One NSQIP study compared outcomes for all microvascular reconstructions by age, but did not differentiate between anatomic regions or control for comorbidities to identify the complications related to age alone (Jubbal, Zavlin, & Suliman, ).…”

Section: Discussionmentioning

confidence: 99%

“…With increased comfort with microvascular reconstruction, microvascular free flap reconstruction in the elderly has been advocated (Beausang et al, ; Howard et al, ; Nao et al, ; Perrot et al, ). However, other studies have noted higher perioperative complications in elderly patients and urged caution (Ferrari et al, ; Goh et al, ; Piazza et al, ; Spyropoulou, Jeng, Hsieh, Tsimponis, & Shih, ; Sugiura et al, ). To date, no large, national studies have evaluated perioperative outcomes and complications following head and neck reconstruction in the elderly population.…”

Section: Introductionmentioning

confidence: 96%

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Impact of advanced age on microvascular reconstruction of the lower facial third: An American College of Surgeons NSQIP study

et al. 2019

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Background: Microvascular reconstruction is the standard of care in head and neck reconstruction, though its perioperative safety in an older population has been controversial due to safety concerns, warranting further investigation. Materials and methods: An"older" (≥71 years) cohort undergoing reconstruction after mandibulectomy/glossectomy was compared to the remaining population in a National Surgical Quality Improvement Program (2008-2016) analysis. Cases required both a mandibulectomy/glossectomy and microvascular or local flap reconstruction (exclusion criteria: missing ages and simultaneous microvascular and local flap reconstruction). Demographics, comorbidities, and procedure types were analyzed on 985 patients (236 [24.4%] were ≥71). Outcomes were compared by reconstruction type. Regressions were performed calculating the impact of age on length of hospital stay (LOHS) and operative time.Results: Ablative procedures were comparable, but older patients received local flaps at higher rates (22.5% vs. 9.6%; p < .001). The older population had more comorbidities (higher ASA class [p < .001], diabetes [p < .001], and hypertension [p < .001]). After Bonferroni correction, univariate subgroup analyses of soft tissue and bone/composite microvascular flaps revealed similar outcomes (except increased medical complications in the older cohort undergoing a bone free flap [p = .002]). Controlling for a variety of factors, older age resulted in longer LOHS (B: 1.4 days; 95% CI: 0.1-2.8 days; p = .035), but not operative time (B: −21.90 min; 95% CI: −52.76 to 8.96 min; p = .164).Conclusion: While increased age (≥70 years) was associated with a longer LOHS, complication rates were comparable. Although limited by the retrospective nature, evidence supports microvascular reconstruction in the elderly population with comparable outcomes.

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The role of age in treatment‐related adverse events in patients with head and neck cancer: A systematic review

et al. 2019

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Head and neck squamous cell carcinoma (HNSCC) is often diagnosed in advanced stage and therefore requires aggressive, multimodal treatment. Elderly patients are often excluded from standard therapy regimens purely based on age. This clinical review aims to collect all published data in the literature on treatment modality selection in elderly patients and on age-related adverse events following treatment of HNSCC. We performed a literature search for articles on the treatment of HNSCC in elderly patients. Most of the articles were retrospective studies with the consequent limitations. It can be concluded that age is not an absolute contraindication for intensive treatment and comorbidity is an important predictor of outcome, but not the only one. Despite the existence of multiple tools for pretreatment evaluation, there are not consistent data on their use.

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Outcome predictors in elderly head and neck free flap reconstruction: A retrospective study and systematic review of the current evidence

Cited by 47 publications

References 25 publications

Relationship between age, comorbidities and complications in head and neck cancer patients undergoing curative surgery

Relationship between age, comorbidities and complications in head and neck cancer patients undergoing curative surgery

Impact of advanced age on microvascular reconstruction of the lower facial third: An American College of Surgeons NSQIP study

The role of age in treatment‐related adverse events in patients with head and neck cancer: A systematic review

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