The effect of age on microsurgical free flap outcomes: An analysis of 5,951 cases

Abstract

Age alone should not be used as an absolute or even relative contraindication in patient assessment. Rather, preoperative assessment should focus on comorbidities and assessment of physiologic age instead of chronologic age. Optimization of these comorbidities is key to sustaining favorable outcomes in microsurgical free flap reconstruction in the elderly population.

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

“…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, ). Given the contamination within oral contents, proximity of critical vascular structures, and complex interplay of oral competence and airway in head and neck reconstruction, it is less clinically useful to group other types (i.e., breast, upper and lower extremity) of microvascular reconstructions with head and neck.…”

Effect of Preoperative Medical Status on Microsurgical Free Flap Reconstructions: A Matched Cohort Analysis of 969 Cases

“…Also, oncologic care has also improved, resulting in an increased number of candidates for microsurgical reconstruction over the last decades. 25 Nonetheless, microvascular reconstructive interventions are often still considered to be relatively risky, mostly due to the high potential of technical difficulties, long duration of the surgical operation, broad dissection areas, compromised tissue perfusion, ischemic injuries, and occurrence of vascular thrombosis. 1,2,5,24,26 Consequently, whether microsurgical free flap reconstruction should also be performed in medically compromised patients is a matter of debate, while good outcomes and low complication rates in elderly and also very old patients.…”

A nationwide analysis of 30‐day adverse events, unplanned readmission, and length of hospital stay after peripheral nerve surgery in extremities and the brachial plexus

“…The data include patient characteristics, postoperative complications, reoperations, readmissions with associated diagnoses, and time to event in days. The NSQIP dataset has been previously validated (Sellers et al, 2013), and has been used to evaluate outcomes for multiple microsurgical procedures (Bydon et al, 2014;Dasenbrock et al, 2015;Garg, Merrell, Hillstrom, & Wolfe, 2011;Jubbal, Echo, Spiegel, & Izaddoost, 2017;Jubbal, Zavlin, & Suliman, 2017;Mlodinow, Ver Halen, Rambachan, Gaido, & Kim, 2013). Our Institutional Review Board has exempted the NSQIP database from review.…”