title: Risk assessment for free tissue transfers: is old age a determining factor?
abstract: BACKGROUND
  Free tissue transfers are more often performed in the elderly with the increase in geriatric patient population. The aim of this study was to investigate the effect of advanced age in reconstructive microsurgery procedures and analyze the association of other variables with complications and surgical success.
  
  
  METHODS
  A retrospective review of 70 consecutive free tissue transfers between January 2012 and June 2013 was performed. Patients were divided into 2 groups: those younger than 60 years and those aged 60 years or older. Besides demographics, the American Society of Anesthesiologists (ASA) risk score, comorbid conditions, and anatomic locations for surgery (head and neck, extremities, trunk), operative time, need for reoperation, intensive care unit (ICU) admission and blood transfusion, length of hospital stay, medical and surgical complications, as well as partial and total flap loss were noted and analyzed.
  
  
  RESULTS
  A total of 71.4% of the patients were younger than 60 years (n = 50; average, 37.4 y), and 28.6% of the patients were 60 years or older (n = 20; average, 67.5 y). None of the other collected data showed significant difference between the groups. Although age was not associated with ICU admission, the location of the reconstruction site and the operative time were found to have a significant correlation with ICU referral. In this series, the operative time correlated with medical complications but not with surgical complications. Higher ASA scores did have a negative effect on the incidence of medical complications (P = 0.028).
  
  
  CONCLUSIONS
  This retrospective review demonstrates that age alone is not an independent variable for increased risk in microvascular reconstruction. However, operative time, ASA risk score, and location of the reconstruction site are more associated with the overall success of free tissue transfers.
authors.affiliation: *Department of Plastic Reconstructive and Aesthetic Surgery, Marmara University School of Medicine, Istanbul †Department of Plastic Reconstructive and Aesthetic Surgery, Adana Numune Teaching and Research Hospital, Adana, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Saçak
authors.forename: Zeynep D
authors.initials: ZD
authors.lastname: Akdeniz
authors.forename: Furkan
authors.initials: F
authors.lastname: Certel
authors.forename: Fatma Nihal Durmuş
authors.initials: FN
authors.lastname: Kocaaslan
authors.forename: Betül
authors.initials: B
authors.lastname: Tuncer
authors.forename: Özhan
authors.initials: Ö
authors.lastname: Çelebiler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D058752:Free Tissue Flaps / Q000009:adverse effects*; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult