title: Postoperative Complications in Elderly Patients Undergoing Head and Neck Surgery: Opportunities for Quality Improvement.
abstract: OBJECTIVE
  To assess the frequency and nature of postoperative complications that occur in elderly patients, as compared with younger patients, following head and neck surgery.
  
  
  METHODS
  Cohort study of national database.
  
  
  METHODS
  American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2013.
  
  
  METHODS
  We identified 29,891 patients who had head and neck surgery during the study period and classified them as having upper aerodigestive tract surgery (n = 8383) or endocrine/salivary gland (n = 21,508) surgery. We analyzed patients stratified by age categories: young (<65 years), intermediate age (65-75 years), and elderly (≥75 years). Risk-adjusted 30-day morbidity and mortality outcomes were compared across age categories with multivariable logistic regression models to adjust for patient characteristics, comorbidities, and surgical procedure.
  
  
  RESULTS
  Elderly patients had increased odds for morbidity (adjusted odds ratio [OR] = 1.47, 95% CI: 1.22-1.78; OR = 1.89, 95% CI: 1.46-2.44) for upper aerodigestive tract and endocrine/salivary gland groups, respectively, versus young patients and for mortality (OR = 2.52, 95% CI: 1.26-5.06; OR = 3.73, 95% CI: 1.32-10.52). Elderly patients were more likely to develop pulmonary, urologic, and blood clotting-related complications. Elderly patients undergoing endocrine/salivary gland surgery were significantly more likely to have cardiac complications; however, this was not the case for aerodigestive tract operations.
  
  
  CONCLUSIONS
  Head and neck surgery in the elderly carries an increased risk of certain types of postoperative complications as compared with younger patients treated similarly. Quality improvement efforts should focus on minimizing the risk of cardiac, pulmonary, and urologic complications in elderly patients.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA john.cramer@northwestern.edu.
authors.forename: John D
authors.initials: JD
authors.lastname: Cramer
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Urjeet A
authors.initials: UA
authors.lastname: Patel
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Samant
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Stephanie Shintani
authors.initials: SS
authors.lastname: Smith
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D011446:Prospective Studies; D058996:Quality Improvement; D012307:Risk Factors; D012466:Salivary Gland Diseases / Q000601:surgery*; D014481:United States / Q000453:epidemiology; D041742:Upper Gastrointestinal Tract / Q000601:surgery*
keywords: National Surgical Quality Improvement Program; elderly; head neck neoplasms; otolaryngology; outcomes; surgery