Flap Reconstruction in Head and Neck Cancer: Age-Dependent Comparison and Trends Over Time
Sabine Egeler, MD, Anna Rose Johnson, MPH, Alexandra Bucknor MBBS, MSc, Austin Chen, BS Anmol Chattha, BA, MPH, Samuel J. Lin, MD, MBA
Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Background: Flap reconstruction (FR) after head and neck cancer excision is often needed. This study aims to compare outcomes in patients ≤45 years and patients >45 years old undergoing head and neck FR.
Methods: Analysis of the Healthcare Cost and Utilization Project National Inpatient Sample Database (NIS) for the years 2009-2014 was undertaken. Data for adults undergoing head and neck FR diagnosed with oral cavity, laryngeal, hypopharyngeal or oropharyngeal malignancy were included. Differences in patient characteristics and surgical outcomes were analyzed. Trends over time were evaluated using the Cochran-Armitage test. Independent predictors of complications were identified using binary regression analysis (presented as odds ratios, OR, with 95% confidence intervals, CI).
Results: A total of 16,655 cases of FR after cancer excision were retrieved. A majority were White (71.3%), males (71.4%). Between patients ≤45 years and >45 years, there were significant differences in gender (p<0.001), race (p<0.001), type of neoplasm (p<0.001) and procedure type (p<0.001). Patients ≤45 years had a decreased risk (OR 0.469, CI 0.397-0.553) of major complications and post-operative hemorrhage (OR 0.424 CI 0.253-0.710). There was a non-uniform decrease in FR in those ≤45 years, however it is unlikely to be clinically significant (202 in 2009 to 210 in 2014, p<0.001). A non-uniform increasing trend in the older group was seen (2317 in 2009 to 3080 in 2014, p<0.001).
Conclusion: Over the years, FR is increasing in the older patient population. This may be due to improvements in perioperative management and preoperative optimization of co-morbidities.
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