Head and Neck Cancer Surgery in the Elderly

Abstract

Objective: With increased life expectancy, there is a growing awareness of the effect of comorbidity on physiologic reserves in elderly surgical patients. We sought to determine the relationship between advanced comorbidity on in-hospital mortality, postoperative complications, length of hospitalization, and costs in elderly patients undergoing head and neck cancer (HNCA) surgery. Method: Discharge data from the Nationwide Inpatient Sample for 36,948 patients aged 65 years and older who underwent ablative surgery for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2003 to 2008 were analyzed using cross-tabulations and multivariate regression. Frail elderly patients were defined as having comorbidity scores of 2 or higher. Results: Frail elderly patients were more likely to be ≥80 years of age (OR 1.2, P = .035) and more likely to require transfer to a short-term hospital (OR = 3.7, P < .001), transfer to another facility (OR = 2.5, P < .001), or home health care (OR = 1.4, P < .001). After controlling for all other variables, frail elderly patients were more likely to develop an acute medical complication (OR = 3.9, P < .001) and had an increased risk of in-hospital mortality (OR = 3.9, P < .001). There was no significant association between frail elderly status and postoperative surgical complications; however, frail elderly status was associated with significantly increased length of hospitalization and hospital-related costs. Conclusion: Advanced comorbidity in elderly HNCA surgical patients is associated with increased short-term mortality and morbidity, length of hospitalization, hospital-related costs, and advanced care following discharge, which may pose a significant challenge to health care reform as the elderly population increases in the future.