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The Age Factor: Exploring Age-related Differences In Outcomes After Free Fibula Mandible Reconstruction
Ayana K. Cole-Price, MD, MSc, Jenny Chen, BA, Annica Stull-Lane, PhD, Bracha Pollack, BA, Geoffrey E. Hespe, MD, Kyeong-Tae Lee, MD, Farooq Shahzad, MBBS, Jonas Nelson, MD, Evan Matros, MD, Babak J. Mehrara, MD, Peter G. Cordeiro, MD, Robert Allen, Jr., MD.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
PURPOSE: To comprehensively assess the impact of age on the outcomes of free fibula flap for oncologic mandibular reconstruction, with a focus on postoperative complications and patient-reported outcomes (PRO).
METHODS: We conducted a retrospective analysis of patients who underwent oncologic mandible reconstruction using fibula flap from 2000-2023. Patients were categorized into four age groups: <50, 50-59, 60-69, and >70 years. Outcome measures included major and minor complications, length of stay, readmission and reoperation, and FACE-Q PRO measure over time.
RESULTS: A total of 436 patients were analyzed, revealing that older patients exhibited a higher prevalence of baseline comorbidities. Compared to the youngest cohort, the group aged over 70 was significantly associated with increased rates of both major complications (40.4%, OR 2.5, p=0.003, CI 0.32 to 1.58) and minor complications (64.6%, OR 2.15, p=0.009, CI 0.19 to 1.33). This group also demonstrated a significantly higher rate of medical complications (11%; p=0.004) and a longer hospital stay (mean 17.8 days, p=0.023). Among surgical site complications, flap failure rates were comparable, while infection rates were significantly increased. However, readmission, reoperation, and all-cause mortality rates did not differ among the groups, and postoperative FACE-Q scores were similar across cohorts
CONCLUSION: Our study suggests that the risk of postoperative complications following bony mandibular reconstruction may increase with age, highlighting the importance of thorough preoperative assessment and tailored postoperative management to achieve optimal outcomes. Nevertheless, FACE-Q scores were comparable across age groups, indicating that older patients achieve similar PROs postoperatively.
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