title: Morbidity and Functional Outcomes With Head and Neck Free Flap Reconstruction in Patients Aged 90 Years or Older.
abstract: OBJECTIVE
  Morbidity of free tissue transfer in the extremes of age is controversial and not well studied in patients aged 90 years or older because of the rarity of these patients and many clinicians' natural hesitancy to perform such a large operation in patients of this group. The purpose of this study was to answer the following clinical question: Do patients aged 90 years or older who undergo free flap reconstruction have worse functional outcomes than their younger counterparts?
  
  
  METHODS
  We performed a retrospective chart review of patients aged 90 years or older who underwent free flap reconstruction at Oregon Health and Science University Hospital from 2000 to 2015. All patients aged 90 years or older undergoing free flap reconstruction were included. Patients younger than 90 years during the same period were randomly selected to serve as controls.
  
  
  RESULTS
  Free flap reconstructions were performed in 14 patients aged 90 years or older, who were then compared with their randomly selected controls. The only statistically significant difference observed in the outcome variables analyzed was the location of discharge from the hospital, with the older patients more likely to be discharged to a skilled nursing facility (P = .002). However, there was no difference in return-to-baseline level of care at last follow-up between the 2 groups. There also was no statistically significant difference in major or minor medical or surgical complication rates, duration of hospitalization, duration of tracheostomy, return to baseline respiratory status, or return to baseline feeding status between the 2 groups.
  
  
  CONCLUSIONS
  Patients aged 90 years or older are more likely to be discharged to a skilled nursing facility than their younger counterparts, but otherwise have similar outcomes in terms of complications and return to baseline function. The results of this study suggest that age 90 years or older should not be a direct contraindication for free flap reconstruction in the head and neck.
authors.affiliation: Oral and Maxillofacial Surgery Resident, Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Fagin
authors.affiliation: Microvascular Surgery Fellow, Department of Otolaryngology, Oregon Health and Science University, Portland, OR.
authors.forename: Savannah
authors.initials: S
authors.lastname: Gelesko
authors.affiliation: Professor of Otolaryngology, Professor of Oral Maxillofacial Surgery, Program Director of Otolaryngology, and Director of Microvascular Reconstruction Fellowship, Department of Otolaryngology, Oregon Health and Science University, Portland, OR.
authors.forename: Mark K
authors.initials: MK
authors.lastname: Wax
authors.affiliation: Assistant Professor of Oral and Maxillofacial Surgery and Director of Head and Neck Oncologic and Microvascular Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR. Electronic address: petrisor@ohsu.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Petrisor
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058752:Free Tissue Flaps / Q000009:adverse effects*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome