Morbidity and Functional Outcomes with Head and Neck Free Flap Reconstruction in Patients Over 90 Years of Age

Publication date: Available online 18 December 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Adam P. Fagin, Savannah Gelesko, Mark K. Wax, Daniel Petrisor
IntroductionMorbidity of free tissue transfer in the extremes of age is controversial and not well studied in patients over ninety due the rarity of these patients and many clinicians' natural hesitance to perform such a large operation on patients of this group. The purpose of this study was to answer the clinical question, "Do patients over the age of ninety who undergo free flap reconstruction have worse functional outcomes than their younger counterparts?"Study DesignRetrospective chart review of patients over ninety years old who underwent free flap reconstruction at OHSU from 2000 to 2015.MethodsAll patients over the age of ninety undergoing free flap reconstruction were included. Patients under the age of ninety during the same time period were randomly selected to serve as controls.ResultsFree flap reconstructions were performed on fourteen patients over the age of ninety, which were then compared to their randomly selected controls. The only statistically significant difference observed in the outcome variables analyzed was the discharge from hospital location, with the older patients more likely to be discharged to a skilled nursing facility (p=0.002). However, there was no difference in return to baseline level of care at last follow-up between the two groups. There was also no statistically significant difference in major or minor medical or surgical complication rates, duration of hospitalization, duration of tracheostomy, return to baseline respiratory status, or return to baseline feeding status between the two groups.ConclusionPatients over ninety are more likely to be discharged to a skilled nursing facility than their younger counterparts, but otherwise have similar outcomes in terms of complications and return to baseline function. The results of this study suggest that age over ninety should not be a direct contraindication for free flap reconstruction for the head and neck.



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