Free tissue transfer in the elderly: Incidence of perioperative complications following microsurgical reconstruction of 197 septuagenarians and octogenarians Journal Article

  

Authors:	Howard, M. A.; Cordeiro, P. G.; Disa, J.; Samson, W.; Gonen, M.; Schoelle, R. N.; Mehrara, B.
Article Title:	Free tissue transfer in the elderly: Incidence of perioperative complications following microsurgical reconstruction of 197 septuagenarians and octogenarians
Abstract:	Background: There are an increasing number of elderly patients requiring free tissue transfer. The risks of complex reconstructions in this patient population remain largely unknown. Therefore, the authors' reason for conducting this study was to review their experience with free tissue transfer in patients aged 70 years or older. Methods: A retrospective review of all free tissue transfers performed over a 10-year period at Memorial Sloan-Kettering Cancer Center was performed and all patients aged 70 years or older were identified. Medical records and the authors' prospectively maintained database were analyzed with respect to comorbidities and postoperative complications. Results: Two hundred eleven patients aged 70 years or older (70 to 79 years, n = 184; 80+ years, n = 27) were identified during the study period. Of these, 197 (70 to 79 years, n = 170; 80+ years, n = 27) patients had complete charts for review. Flap survival was 100 percent in the 80+ group and 97 percent in the 70 to 79 group. The overall complication rate was 59.3 percent in the 80+ group and 35.3 percent in the 70 to 79 group (p = 0.030). The medical complication rate was 40.7 percent in octogenarians and 11.8 percent in septuagenarians (p = 0.0004). Overall surgical complications were similar in the two groups. Univariate analysis demonstrated that age was associated with medical complications but not surgical complications. Using multivariate analysis, the authors found that alcohol use and coronary artery disease were independent predictors of overall, medical, and surgical complications. Conclusions: Free tissue transfer may be performed in patients over age 70 with a high degree of technical success. The procedure, however, carries a distinct risk of perioperative mortality and morbidity, particularly in patients over the age of 80. Comorbidities significantly associated with complications include age, alcohol use, coronary disease, and hypertension. This study suggests that prolonged survival may be achieved in some patients; however, a selective approach is required.
Keywords:	survival; aged; aged, 80 and over; surgical technique; retrospective studies; major clinical study; review; surgical flaps; hypertension; incidence; smoking; microsurgery; high risk patient; postoperative complication; postoperative complications; diabetes mellitus; experience; comorbidity; aging; multivariate analysis; perioperative period; free tissue graft; alcohol drinking; lung diseases; tissue transplantation; coronary disease
Journal Title:	Plastic and Reconstructive Surgery
Volume:	116
Issue:	6
ISSN:	0032-1052
Publisher:	Lippincott Williams & Wilkins
Date Published:	2005-11-01
Start Page:	1659
End Page:	1668
Language:	English
DOI:	10.1097/01.prs.0000187135.49423.9f
PUBMED:	16267429
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-27744477866&partnerID=40&md5=478dc37271fdb592470b98181bd6ce16
Notes:	--- - "Cited By (since 1996): 23" - "Export Date: 24 October 2012" - "CODEN: PRSUA" - "Source: Scopus"

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