Postoperative complications in elderly patients undergoing head and neck surgery: Opportunities for quality improvement

Objective To assess the frequency and nature of postoperative complications that occur in elderly patients, as compared with younger patients, following head and neck surgery. Study Design Cohort study of national database. Setting American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2013. Subjects and Methods We identified 29,891 patients who had head and neck surgery during the study period and classified them as having upper aerodigestive tract surgery (n = 8383) or endocrine/salivary gland (n = 21,508) surgery. We analyzed patients stratified by age categories: young (<65 years), intermediate age (65-75 years), and elderly (≥75 years). Risk-adjusted 30-day morbidity and mortality outcomes were compared across age categories with multivariable logistic regression models to adjust for patient characteristics, comorbidities, and surgical procedure. Results Elderly patients had increased odds for morbidity (adjusted odds ratio [OR] = 1.47, 95% CI: 1.22-1.78; OR = 1.89, 95% CI: 1.46-2.44) for upper aerodigestive tract and endocrine/salivary gland groups, respectively, versus young patients and for mortality (OR = 2.52, 95% CI: 1.26-5.06; OR = 3.73, 95% CI: 1.32-10.52). Elderly patients were more likely to develop pulmonary, urologic, and blood clotting-related complications. Elderly patients undergoing endocrine/salivary gland surgery were significantly more likely to have cardiac complications; however, this was not the case for aerodigestive tract operations. Conclusions Head and neck surgery in the elderly carries an increased risk of certain types of postoperative complications as compared with younger patients treated similarly. Quality improvement efforts should focus on minimizing the risk of cardiac, pulmonary, and urologic complications in elderly patients.