(0696) Outcomes and Complications After Flap Reconstruction in Geriatric Versus Non-Geriatric Head and Neck Cancer Patients

Introduction: This study seeks to define and compare outcomes in head and neck reconstruction among geriatric vs non-geriatric populations including discharge, complications, and cost outcomes.

Methods: A population-based cross-sectional study utilizing the National Inpatient Sample between 2016-2020. Hospital admissions were identified where an ablative head and neck cancer procedure was performed followed by a pedicled or free flap reconstruction using ICD-10 procedural codes. Patients were categorized as geriatric (age ≥ 65) or non-geriatric (age < 65). Outcomes of interest included discharge disposition (home vs non-home discharge) medical and surgical complications, cost of inpatient care, and length of stay. Temporal trends in the proportional utilization of flap reconstruction among geriatric patients and predictors of discharge outcomes, complications, cost, and length of stay were calculated using Cochrane-Armitage testing and survey-weighted regression models.

Results: There were 6,905 ablative procedures with a concurrent flap reconstruction between 2016 and 2020. Among these, 3,300 (47.8%%) occurred in geriatric patients. There was a significant increase in the proportion of total flap reconstructions that occurred in geriatric patients from 455 (44.4%) in 2016 to 860 (51.5%) in 2020 (p < 0.01). Geriatric patients were more likely to have a non-home discharge (OR[95% CI]: 2.5 [1.9-3.2], p < 0.01) and have a medical complication during the admission (OR[95% CI]: 1.5 [1.2-1.9], p < 0.01). However, there were no significant differences in surgical complications, cost, or length of stay between geriatric and non-geriatric patients.

Conclusions: As life expectancy increases, a greater proportion of head and neck cancer patients are geriatric. Major reconstructive procedures are performed with significantly increased frequency in this aging population, Geriatric patients were less likely to be discharged home and more likely to experience a medical complication during their admission. These data may help inform decision making around advanced procedures and expected outcomes in this population.