RESUMEN
The aim of this study was to assess the impact of the different subtypes of patient comorbidities on the outcomes of head and neck microvascular reconstruction. A total of 423 patients who underwent head and neck free flap reconstruction in our institution between 2000 and 2010 were included in this retrospective study. The impact of the different subtypes of patient comorbidities (as defined by the Kaplan-Feinstein Index) and other global health status-related factors on free flap success, local and general complications, postoperative mortality and length of stay was assessed in univariate and multivariate analysis. We found no correlation between patient comorbidities and free flap failure. In multivariate analysis, we demonstrated a significant correlation between tobacco consumption (p = 0.04) and local complications. Gastro-intestinal comorbidity (p = 0.005) and malnutrition (p = 0.02) were associated with a higher risk of fistula formation. Diabetes mellitus (p = 0.003), gastro-intestinal (p = 0.02), systemic (p = 0.02) and cardiac comorbidities (p = 0.03) were significant predictors of medical complications. We concluded that the different subtypes of patient comorbidities were relevant predictors of complications in head and neck microvascular reconstruction.
Asunto(s)
Colgajos Tisulares Libres/irrigación sanguínea , Neoplasias de Cabeza y Cuello/epidemiología , Procedimientos de Cirugía Plástica , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Vasculares , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Diabetes Mellitus/epidemiología , Femenino , Fístula , Enfermedades Gastrointestinales/epidemiología , Neoplasias de Cabeza y Cuello/cirugía , Estado de Salud , Humanos , Tiempo de Internación , Masculino , Desnutrición/epidemiología , Persona de Mediana Edad , Análisis Multivariante , Estudios Retrospectivos , Factores de Riesgo , Fumar/epidemiología , Resultado del Tratamiento , Adulto JovenRESUMEN
CONCLUSION: This was the first study to specifically demonstrate the validity of ablative surgery and free flap reconstruction for elderly patients with oral or oropharyngeal cancer in terms of oncologic and functional outcomes. OBJECTIVE: The aim of our study was to evaluate the impact of advanced age on oncologic and functional outcomes after ablative surgery and free flap reconstruction in patients with oral or oropharyngeal cancer. METHODS: We conducted a retrospective review of the medical records of all patients who underwent ablative surgery and reconstruction with free flap for primary oral or oropharyngeal cancer at our institution between 2000 and 2009. The impact of advanced age (≥70 years) on oncologic and functional outcomes was assessed in univariate and multivariate analyses. RESULTS: Advanced patient age had a worse impact on overall (p = 0.006), specific (p = 0.02) and disease-free (p = 0.03) survival in univariate analysis, but had only a worse impact on overall survival (p = 0.03) in multivariate analysis. In the elderly patients, overall, specific and disease-free survival rates at 5 years were 43%, 51% and 49%, respectively. There was no significant difference in functional outcomes between elderly and young patients.