title: Assessment of advanced age as a risk factor in microvascular breast reconstruction.
abstract: BACKGROUND
  The population of elderly people is the fastest growing population in the United States. Because breast cancer typically affects the elderly population, surgeons will be performing more mastectomies in older patients. In this study, we evaluate the risks of microvascular breast reconstruction as a function of increasing age.
  
  
  METHODS
  Between July 2002 and September 2009, a retrospective analysis of 818 free-flap breast reconstructions was used to assess the risk of age on surgical outcomes. Patient comorbidities, the American Society of Anesthesiologists (ASA) classification, and length of hospital stay were used to assess the rates of complications among our age cohorts.
  
  
  RESULTS
  Advanced age was not associated with increased complications (P > 0.69). ASA class was a significant predictor of overall complications (P < 0.03) as well as the rate of fat necrosis (P < 0.01) and hematoma (P < 0.001). Flap loss occurred in 1.5% of operations, but there was no difference among the various age groups. Previous surgery was associated with an increased risk of flap loss (P < 0.001), and hypertension also increased the risk of thrombosis (P < 0.04). There was no difference in mean length of hospital stay (4.27 days).
  
  
  CONCLUSIONS
  Advanced age should not be considered a risk factor for microvascular breast reconstruction. Because ASA status did predict overall surgical complications, surgeons should consider the patients' overall health status in deciding whether to operate.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of California Los Angeles, Los Angeles, CA 90095, USA.
authors.forename: Eric I
authors.initials: EI
authors.lastname: Chang
authors.forename: Luis
authors.initials: L
authors.lastname: Vaca
authors.forename: Andrew L
authors.initials: AL
authors.lastname: DaLio
authors.forename: Jaco H
authors.initials: JH
authors.lastname: Festekjian
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Crisera
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008866:Microsurgery; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012306:Risk; D055815:Young Adult