Safety of Reconstructive Microsurgery in the Elderly Population: a Multicentric Prospective Study

Abstract

Background: Safety of reconstructive microsurgery in elderly patients is still a topic of debate, because no conclusive evidence exists that provides indications and risk evaluation in elderly patients. The purpose of this study, which the Italian Society for Plastic, Reconstructive, and Aesthetic Surgery (SICPRE) has promoted, is to evaluate the safety and the complication risk of elective reconstructive microsurgery in elderly patients as well as to identify patient-or procedurerelated risk factors. The secondary aim is to evaluate the predictive role for complications of the Geriatric 8 score (G8). Methods: A total of 194 consecutive patients from 18 centers, aged 65 or older, who received an elective microsurgical flap between April 2018 and April 2019 were prospectively evaluated. Patient-related, treatment-related, and outcomes data were recorded and statistically analyzed through multiple-adjusted logistic regression models. Results: Our study showed an increased risk of complications and a longer hospitalization in patients aged ≥75 years with the American Society of Anesthesiologists (ASA) score ≥3 (or G8 score ≤11) as compared to patients > 65 years of age and < 75 years of age who undergo reconstruction with a microsurgical flap. Instead, flap survival did not significantly vary with age, but was associated only with ASA score ≥3 (or G8 score ≤11) and surgeries that last longer than 480 min; however, flap survival (92.3%) was slightly lower than that commonly reported for in the general population. Conclusions: Reconstructive microsurgery in the elderly is generally safe. The ASA score is easier and quicker than the G8 score and equally useful for risk stratification.

Free Flaps for Skin and Soft Tissue Reconstruction in the Elderly Patient: Indication or Contraindication

“…However, it is also a highly subjective assessment by the anesthesiologist, as several studies showed significantly weak inter-rater reliability [ 35 ]. Even when other parameters, such as the G8 score, are used to define frailty as a parameter for postoperative mortality, morbidity, and prolonged recovery, no significant differences could be demonstrated in the assessment of these values compared with the ASA score [ 36 ]. As shown in our study but also in other studies, free flap transfer per se is no longer a contraindication for elderly or very old patients.…”

DIEP flap perfusion assessment using microdialysis versus Doppler ultrasonography: A comparative study

“…Age was not considered a contraindication. (Cordova et al, 2021; Laporta, Sorotos, et al, 2017) Frail patients with an ASA score above III and/or with a contraindication for abdominal free flaps (i.e., previous abdominal surgeries, low body mass index [BMI], insufficient donor tissues) received different reconstructive options and were excluded from the study.…”