Department of Oral and Maxillofacial SurgeryInstitute for Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany.
J Am Geriatr Soc. 2011 Mar;59(3):398-405. doi: 10.1111/j.1532-5415.2011.03315.x.
To compare perioperative problems and outcomes of reconstructive surgery with microvascular flaps of a group of older (≥ 70) and younger adults (20-69).
Prospective clinical cohort study.
Maxillofacial surgical unit of a university teaching hospital in Munich, Germany.
Two hundred fifteen people with head and neck carcinoma (older: n = 54, mean age 75.8, range 70-96; younger: n = 161, mean age 55.5, range 20-69) who underwent surgery between 2007 and 2009.
Participant characteristics: age, sex, American Society of Anesthesiologists (ASA) status, tumor type, preoperative radiation or chemotherapy, medical comorbidities. Surgical variables: flap type, type of reconstruction (primary/secondary), length of operation (minutes). Postoperative variables: length of stay (minutes) on intensive care unit (ICU), reasons for ICU stay longer than 1,500 minutes (surgical or medical), length of hospitalization (days), and reasons for hospitalization longer than 20 days (surgical or /medical). Short-term outcome within 30 days: revisions, flap success, overall complication rate, mortality.
Older adults had a higher ASA class (P < .001) and shorter duration of surgery (P = .02). Age as an independent factor prolonged stay on ICU (P = .008) and was associated with a higher complication rate (P = .003) but had no influence on length of hospitalization, flap success, need for revisions, or mortality.
Although higher rates of peri- and postoperative difficulties must be expected when microvascular reconstructive surgery is considered for older adults, careful surgical technique, adequate postoperative surveillance, and immediate management of complications can facilitate outcomes comparable with those for younger adults.
比较一组老年（≥70 岁）和年轻成人（20-69 岁）接受微血管皮瓣重建手术的围手术期问题和结果。
前瞻性临床队列研究。
德国慕尼黑大学教学医院的颌面外科病房。
2007 年至 2009 年间接受手术的 215 名头颈部癌患者（老年组：n=54，平均年龄 75.8 岁，范围 70-96 岁；年轻组：n=161，平均年龄 55.5 岁，范围 20-69 岁）。
参与者特征：年龄、性别、美国麻醉医师协会（ASA）分级、肿瘤类型、术前放疗或化疗、合并症。手术变量：皮瓣类型、重建类型（一期/二期）、手术时间（分钟）。术后变量：入住重症监护病房（ICU）的时间（分钟）、入住 ICU 时间超过 1500 分钟的原因（手术或医疗）、住院时间（天）和住院时间超过 20 天的原因（手术或/医疗）。30 天内的短期结果：翻修、皮瓣成活率、总体并发症发生率、死亡率。
老年患者的 ASA 分级较高（P<0.001），手术时间较短（P=0.02）。年龄作为一个独立因素，延长了 ICU 入住时间（P=0.008），并与更高的并发症发生率相关（P=0.003），但对住院时间、皮瓣成活率、翻修需求或死亡率无影响。
虽然在考虑对老年患者进行微血管重建手术时，预计会出现更高的围手术期困难，但通过仔细的手术技术、充分的术后监测以及对并发症的及时处理，可以实现与年轻患者相当的结果。
