Increased Patient Age As A Risk Factor Following Free Flap Reconstruction After Breast Cancer: A Single Institutional Review Of 2,300 Cases
Stephanie E. Honig, MD, Theodore E. Habarth Morales, BS, 1LT, USAR, NRAEMT, Harrison D. Davis, BS, Ellen F. Niu, BS, Chris Amro, MD, Robyn B. Broach, PhD, Joseph M. Serletti, MD, Said C. Azoury, MD.
University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE: Elderly patients are increasingly undergoing free flap breast reconstruction (FF-BR). However, some surgeons do not offer FF-BR to patients of advanced age due to perceived increased peri-operative risk. The authors sought to determine the risks of FF-BR with increasing patient age.
METHODS: Patients undergoing FF-BR at our institution from 2005-2018 were included. Logistic regression models were fit to determine association of age with probability of all complications, venous thromboembolism (VTE), surgical site infection (SSI), flap loss, and mortality. ROC (receiver operating characteristic) curve analyses were performed to predict optimal age cutoff by outcome. Generalized linear modeling (with spline regression) was then used to graph risk of outcomes over continuous age.
RESULTS: A cohort of 2,300 with an average age of 51.5 years (SD 6.5) was identified. Odds of multiple post-operative complications increased after the age of 50 though this risk attenuated between 60-65 years and did not marginally increase thereafter. FF-BR after age 60 was associated with higher risk of VTE. There were no differences in length of stay or odds of SSI, flap loss, or risk-adjusted mortality with increasing age (Figure).
CONCLUSION: While a set age cutoff for patients undergoing FF-BR does not appear warranted, older age does predispose patients to specific complications which should guide preoperative counseling. Further, additional consideration should be given to optimal VTE prophylaxis for elderly patients undergoing FF-BR.
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