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Peri-operative outcomes following major surgery for head and neck cancer in the elderly: institutional audit and case–control study

Published online by Cambridge University Press:  03 August 2018

N Subramaniam ,
D Balasubramanian ,
P Rka ,
P Rathod ,
S Murthy ,
S Vidhyadharan ,
S Rajan ,
J Paul ,
K Thankappan  and
S Iyer
N Subramaniam
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
D Balasubramanian*
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
P Rka
Affiliation:
Department of Otorhinolaryngology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
P Rathod
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
S Murthy
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
S Vidhyadharan
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
S Rajan
Affiliation:
Department of Anaesthesia, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
J Paul
Affiliation:
Department of Anaesthesia, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
K Thankappan
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
S Iyer
Affiliation:
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
*
Author for correspondence: Dr Deepak Balasubramanian, Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India E-mail: deepakbala@live.com
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Abstract

Objective

Elderly patients have been consistently shown to receive suboptimal therapy for cancers of the head and neck. This study was performed to determine the peri-operative outcomes of these patients and compare them with those of younger patients.

Methods

In this retrospective analysis, 115 patients aged 70 years or more undergoing major surgery for head and neck cancers were matched with 115 patients aged 50–60 years, and univariate analysis was performed.

Results

Elderly patients had a reduced performance status (p < 0.001) and more co-morbid illnesses (p = 0.007), but a comparable intra-operative course. They had a longer median hospital stay (p = 0.016), longer intensive care unit stay (p = 0.04), longer median tracheostomy dependence (p = 0.04) and were more often discharged with feeding tubes (p < 0.001). They also had a higher incidence of post-operative non-fatal cardiac events (p = 0.045).

Conclusion

Elderly patients with good performance status should receive curative-intent surgery. Although hospital stay and tube dependence are longer, morbidity and mortality are comparable with younger patients.

Keywords

Perioperative MorbiditySurgical OutcomesElderlyGeriatrics
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 8 , August 2018 , pp. 742 - 747
Copyright
Copyright © JLO (1984) Limited, 2018 

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Footnotes

Dr D Balasubramanian takes responsibility for the integrity of the content of the paper

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