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The effect of age on microsurgical free flap outcomes: An analysis of 5,951 cases
Author(s) -
Jubbal Kevin T.,
Zavlin Dmitry,
Suliman Ahmed
Publication year - 2017
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.30189
Subject(s) - medicine , univariate analysis , surgery , confounding , complication , retrospective cohort study , quality of life (healthcare) , multivariate analysis , population , free flap , nursing , environmental health
Background The growing elderly population necessitates a greater number of aging patients requiring complex reconstructive surgery involving free tissue transfer. The purpose of this study was to assess the safety, efficacy, and outcomes of microsurgical free tissue transfer in elderly patients using a national multi‐institutional database. Methods We performed a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify patients undergoing free tissue transfer. We stratified cohorts based on ages 18–49, 50–59, 60–69, 70–79, and 80+ years and analyzed primary outcomes of surgical complications, medical complications, mortality, and flap failure. Results A total of 5,951 patients were identified for inclusion in the analysis. Univariate analysis demonstrated progressively increasing surgical ( P = .001) and medical ( P < .001) complication rates with increasing age. After controlling for confounding variables, age was not significantly associated with rates of surgical (OR 1.00, 95% CI 0.99–1.01, P = .737) or medical (OR 1.01, 95% CI 0.99–1.03, P = .209) complications, flap failure (OR 1.00, 95% CI 1.00–1.02, P = .689), or reoperation (OR 1.01, 95% CI 1.00–1.03, P = 0.165). Factors associated with surgical complications included BMI (OR 1.03, 95% CI 1.00–1.05, P = .031), prolonged operative time (OR 1.001, 95% CI 1.000–1.002, P = .002), American Society of Anesthesiologists (ASA) classification of 3 or greater (OR 1.62, 95% CI 1.17–2.23, P = .003), and prolonged hospitalization (OR 1.03, 95% CI 1.02–1.04, P < .001). ASA classification of 3 or greater (OR 2.57, 95% CI 1.48‐4.45, P = .001), renal history (OR 10.13, 95% CI 1.57–65.55, P = .015), and prolonged hospitalization (OR 1.06, 95% CI 1.04‐1.08, P < .001) were associated with medical complications. Age was associated with increased mortality (OR 1.06, 95% CI 1.00–1.13, P = .048). Conclusion 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.