The systematic review and meta-analysis of free flap safety in the elderly patients.
BACKGROUND
Prolonged mean life expectancy gives rise to a more populated and older patient group. With increasing number of cases during the past decades, older patients are regarded as candidates for microsurgical interventions. Whether advanced patient age is an independent risk factor for microsurgical reconstruction is still an ongoing matter of debate.


METHODS
The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, CINAHL and EMBASE databases were screened for combination of the key words "elderly", "geriatric", "advanced age", "free flap", "microsurgery", free tissue transfer" by using time limits between 1989 and 2015.


RESULTS
According to results of the meta-analysis, there was no significant difference in the flap success rates(P =.39, CI = 0.848 to 2.329) and surgical complication rates (P = .83, CI = 0.792 to 1.163) between the young and elderly patient groups. However, the systemic complication rates(P = .02, CI = 1.468 to 3.572), preoperative ASA scores(P < .0001, CI = 0.342 to 1.078), and mortality rates (P = .03, CI = 2.636 to 9.055) were found to be significantly higher in the elderly patients.


CONCLUSIONS
Although an increased rate of systemic complications and mortality has been associated with advanced age, our study results showed no significant difference between the flap success rates and surgical complications. A successful reduction in systemic complications would bring the risk level of reconstructive microsurgical interventions of the elderly patient group to the level of the young patient group. © 2017 Wiley Periodicals, Inc. Microsurgery 37:442-450, 2017.
Department of Plastic Surgery, Hacettepe University Hospitals, Ankara, Turkey.
Galip Gencay
GG
Üstün
Department of Plastic Surgery, Hacettepe University Hospitals, Ankara, Turkey.
Ali Emre
AE
Aksu
Department of Plastic Surgery, Hacettepe University Hospitals, Ankara, Turkey.
Hakan
H
Uzun
Department of Plastic Surgery, Hacettepe University Hospitals, Ankara, Turkey.
Ozan
O
Bitik
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D015233:Models, Statistical; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods*; D012307:Risk Factors