Postoperative morbidity in head and neck cancer ablative surgery followed by microsurgical free tissue transfer in the elderly

Abstract

Objective: To identify the risk factors for postoperative morbidities in elderly patients (≧65 years old) who underwent head and neck tumor ablation followed by immediate free tissue transfer.

Methods: We performed a retrospective analysis of 1012 patients who underwent free tissue transfer after head and neck cancer ablation between 2007 and 2010. A total of 167 patients aged 65 and older were identified. These patients were divided into two age-related subgroups: patients aged between 65 and 70 years in one cohort and patients older than 70 years in the second cohort. The demographic and operative variables as well as postoperative medical and surgical morbidities were analyzed.

Results: The older group had significantly prolonged ICU stay (p = 0.014) and hospital stay (p = 0.039). The same group also had higher rates of intraoperative blood transfusion ≧2 units (p = 0.019), unplanned reintubation (p < 0.001), medical (p = 0.004), and surgical (p < 0.001) complications. The intraoperative blood loss of >220 mL was a significant predictive factor for postoperative medical morbidities (odds ratio [OR] 2.25; 95% confidence interval [CI], 1.01-5.03; p = 0.048). The age of >70 years was an independent risk factor for postoperative medical and surgical morbidity (OR [95% CI]: 4.08 [1.67-9.99] and 3.48 [1.56-7.78], p = 0.002, respectively).

Conclusions: Age over 70 years and intraoperative blood loss of >220 mL are significant risk factors for predicting postoperative morbidity, and a thorough pre-treatment evaluation and care for elderly patients are required.