Background: Microvascular free flap reconstruction of the head and neck is a common technique utilised across many ages. The purpose of this study was to identify if advanced age or comorbidity was associated with worse postoperative outcomes in patients undergoing free flap reconstruction.
Methods: A retrospective analysis was performed on 344 consecutive patients undergoing free flap surgery of the head and neck. Demographic, clinical and pathological factors were considered along with Charlson Comorbidity Index scores (CCI) and American Society of Anaesthesiologist (ASA) status. Logistic regression analysis was used to investigate the association of age, CCI or ASA with postoperative complications.
Results: Elderly patients (≥75 years) had a higher overall complication rate (OR 1.7, p =0.04) that was restricted to medical complications (OR 2.1, p = 0.05) and not surgical complications (OR 1.4, p=0.14). Reconstructions of defects from cutaneous malignancy predominated in the elderly cohort (48% vs 29%, p<0.01), but there was no difference in complication rate when cutaneous or mucosal subgroups were separated by age or flap type (Osseous vs. Soft tissue). ASA IV was weakly associated with surgical complications (OR 3.89, p=0.053), but CCI and elderly age were not associated with any outcome. Median length of stay was similar between age groups.
Conclusion: Free flap reconstruction in older patients was associated with increased medical complications, and surgical complications were weakly associated with ASA status. Advanced age or comorbidity should not preclude microvascular reconstruction, but comorbid status should be optimised preoperatively and factors predisposing to medical complications minimised where possible.