Incidence of Peri-Operative Complications Following Microsurgical reconstruction of
211 Septuagenarians and Octogenarians
Babak J. Mehrara, MD; Michael A. Howard, MD; William Samson, MD; Peter G.
Cordeiro, MD; Joseph J. Disa, MD; Robin Schoelle, PA
There are an increasing number of elderly patients requiring free tissue transfer.(1) The
risks of complex reconstructions in this patient population remain largely unknown.(2)
Therefore, the purpose of this study was to review our experience with free tissue transfer
in patients >70 years old.
A retrospective review of all free tissue transfers performed over a ten year period at
Memorial Sloan-Kettering Cancer Center was performed and all patients >70 years old
were identified. Medical records and our prospectively maintained database were
analyzed with respect to co-morbidities and postoperative complications.
211 patients aged >70 years (70-79yrs= 184; >80 yrs= 27) were identified during the
study period. Of these, 197 patients had complete charts to review. Both groups were
similar in their demographics. Flap survival was 100% in the 80+ and 97% in 70-79
groups. The overall complication rate was 59.3% in the 80+ group and 35.3% in the 7079 group (p=0.030). The medical complication rate was 40.7% in octogenarians and
11.8% in septuagenarians (p=0.0004). Overall surgical complications were similar in the
two groups. Univariate analysis demonstrated that age was associated with medical
complications. Using multivariate analysis, we found that alcohol use and coronary
artery disease were independent predictors of overall, medical, and surgical
complications.
In summary, free tissue transfer may be performed in patients over age 70 with a high
degree of technical success. The procedure however, carries a distinct risk of perioperative mortality and morbidity particularly in patients over the age of 80. Comorbidities significantly associated with complications include age, alcohol use, coronary
disease, and hypertension. This study suggests that prolonged survival may be achieved
in some patients; however, a selective approach is required.
Table 3: Outcomes: Peri-operative Complications and Mortality
Complication
Overall Complications
Overall Medical
Major
Death (CV-Resp fail)
Prolonged intubation
Pneumonia
PE
MI
Overall
(n=197)
38.6
15.7
14.2
8.6
1.5
2.5
1.0
1.0
70-79 (n=170)
80+ (n=27)
P-value
35.3
11.8
11.1
7.1
1.8
2.4
0.6
0.6
59.3
40.7
33.3
18.5
0.0
3.7
3.7
3.7
0.03
0.0004
ns
ns
ns
ns
ns
ns
UGI bleed
Minor
Overall Surgical
Major
Total flap loss
Hematoma
Venous thrombosis
Arterial thrombosis
Death (carotid rupture)
Cranial abscess
Other
Minor
Flap success
Peri-op mortality
0.5
1.5
27.9
10.7
3.0
2.5
2.0
1.5
0.5
0.5
0.5
17.8
97
9.1
0.0
0.5
27.6
10.0
3.5
2.9
1.2
1.2
1.2
1.2
0.0
15.7
96.5
7.7
3.7
7.4
29.6
14.8
0.0
0.0
7.4
3.7
0.0
0.0
7.4
14.8
100
18.5
ns
ns
ns
ns
ns
ns
ns
ns
ns
ns
ns
ns
ns
0.07
ns= not significant
Reference List
1. U.S. Census Projections. U.S.Census Bureau . 2004.
2. Beausang, E. S., Ang, E. E., Lipa, J. E. et al. Microvascular free tissue transfer in
elderly patients: the Toronto experience. Head & Neck. 25: 549, 2003.