title: Head and neck free flap reconstruction in patients older than 80 years.
abstract: BACKGROUND
  Free tissue transfer is a reliable method for reconstruction of head and neck defects. With the growing number of octogenarians in the population, it is important to understand how these patients respond to these procedures.
  
  
  METHODS
  Through a retrospective chart review of patients who underwent a free-flap reconstruction from 2000 to 2010 at an academic medical center, 48 patients, aged 80 years and older, were compared with a control group consisting of 97 similar patients, aged younger than 80 years. We compared the intensive care unit (ICU) length of stay, overall hospital stay, and the incidence of perioperative complications between the cohorts.
  
  
  RESULTS
  The average length of stay in the ICU was significantly longer for the octogenarian group as compared with the younger group (101 vs. 41 hours, p-value = 0.007). The average length of hospital stay was not significantly different between the two groups (difference = 40 hours, p-value = 0.102). The incidence of perioperative complication was 75% in the octogenarian group and 60% in the younger group (p-value = 0.095). There were two flap failures in the younger group, and none in the octogenarian group. There was a significantly higher rate of death within 30 days in the octogenarian group.
  
  
  CONCLUSIONS
  Microvascular free tissue transfer is a reliable and safe method of reconstruction of head and neck defects in patients over 80 years of age. Patients should be counseled about the potential risks of increased incidence of medical complications, ICU length of stay, and rate of perioperative death when recommended to undergo free tissue transfer reconstruction.
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
authors.forename: Prabhat K
authors.initials: PK
authors.lastname: Bhama
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington.
authors.forename: Sapna A
authors.initials: SA
authors.lastname: Patel
authors.affiliation: Seattle Children's Research Institute, Seattle, Washington.
authors.forename: Umer
authors.initials: U
authors.lastname: Khan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington.
authors.forename: Amit D
authors.initials: AD
authors.lastname: Bhrany
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington.
authors.forename: Neal D
authors.initials: ND
authors.lastname: Futran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D058752:Free Tissue Flaps / Q000098:blood supply*; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011183:Postoperative Complications / Q000401:mortality*; D017410:Practice Guidelines as Topic; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology