American Association of Plastic Surgeons

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The Impact of Age on Outcomes Following Pedicled Flap Reconstruction: An Analysis of 44,986 Cases
Nicholas G. Cuccolo, BS, Sebastian Sparenberg, MD, Dustin T. Crystal, BS, Ahmed M.S. Ibrahim, MD, PhD, Louise L. Blankensteijn, MD, Samuel J. Lin, MD, MBA.
Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.

Background: The United States population is aging rapidly, and with advancements in anesthesia, the proportion of elderly patients undergoing surgery each year has risen in parallel. The aim of this study was to evaluate the effect of age on postoperative outcomes following pedicled flap reconstruction.
Methods: We reviewed the ACS-NSQIP database to identify cases involving pedicled flaps based on Current Procedural Terminology codes. Subjects were divided into age groups 18-49, 50-59, 60-69, 70-79, and > 80 years. Demographic data and postoperative complications were assessed using Chi-square and t-tests for analysis of categorical and continuous variables, respectively. A multivariate regression analysis was conducted to control for confounding variables.
Results: A total of 44,986 cases were analyzed, of which, 10.2% were head and neck, 79.2% breast and trunk, 1.3% upper extremity, 8.7% lower extremity, and 0.6% decubitus ulcer. The incidence of wound, major surgical, and all-cause postoperative complications was 9.1, 6.8, and 25.9%, respectively. Univariate analysis showed increasing rates of postoperative complications with increasing age (p<0.001). Age was associated with a significantly higher rate of all-cause (OR 1.004, 95%CI 1.002-1.004, p<0.001) and major (OR 1.007, 95%CI 1.003-1.010, p<0.001) complications. Other factors associated with all-cause complications were BMI (OR 1.004, 95%CI 1.001-1.007, p=0.008), smoking (OR 1.426, 95%CI 1.344-1.512, p<0.001), and ASA classification of 3 or greater (OR 2.150, 95%CI 2.003-2.274, p<0.001).
Conclusion: The elderly population is at an increased risk of postoperative complications following pedicled flap reconstruction. As such, surgeons should thoroughly assess the feasibility of alternative reconstructive options when evaluating elderly patients.


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