Semin Plast Surg 2010; 24(3): 319-324
DOI: 10.1055/s-0030-1263073
© Thieme Medical Publishers

The Old and Ill: Influence and Impact on the Reconstructive Effort

O. Koray Coşkunfırat1 , Ömer Özkan1
  • 1Department of Plastic and Reconstructive Surgery, Akdeniz University School of Medicine, Antalya, Turkey
Further Information

Publication History

Publication Date:
20 August 2010 (online)

ABSTRACT

Head and neck reconstruction is often mandatory in elderly and ill patients, especially after tumor ablation. Even complex reconstructive procedures can be done in the elderly population after careful evaluation. The morbidity and mortality rates increase with age, thus the risks and benefits of surgical intervention must be weighed precisely. The functional capacities of the vital organs and the limitations should be assessed. The only significant preoperative guide for the risk of the operation is the American Society of Anesthesiologists (ASA) score. According to this scoring system, ASA 3 and 4 patients are more prone to complications. For a successful reconstructive procedure in old and ill patients, detailed preoperative evaluation is mandatory. Based on this evaluation, the type and duration of the surgery can be properly selected, and postoperative monitoring can be handled individually.

REFERENCES

  • 1 Polanczyk C A, Goldman L, Marcantonio E R, Orav E J, Lee T H. Supraventricular arrhythmia in patients having noncardiac surgery: clinical correlates and effect on length of stay.  Ann Intern Med. 1998;  129(4) 279-285
  • 2 Williams M E. Clinical implications of aging physiology.  Am J Med. 1984;  76(6) 1049-1054
  • 3 Mohr D N. Estimation of surgical risk in the elderly: a correlative review.  J Am Geriatr Soc. 1983;  31(2) 99-102
  • 4 Anon . New classification of physical status.  Anesthesiology. 1963;  24 111
  • 5 Serletti J M, Higgins J P, Moran S, Orlando G S. Factors affecting outcome in free-tissue transfer in the elderly.  Plast Reconstr Surg. 2000;  106(1) 66-70
  • 6 Shaari C M, Buchbinder D, Costantino P D, Lawson W, Biller H F, Urken M L. Complications of microvascular head and neck surgery in the elderly.  Arch Otolaryngol Head Neck Surg. 1998;  124(4) 407-411
  • 7 Coskunfirat O K, Chen H C, Spanio S, Tang Y B. The safety of microvascular free tissue transfer in the elderly population.  Plast Reconstr Surg. 2005;  115(3) 771-775
  • 8 Ozkan O, Ozgentas H E, Islamoglu K, Boztug N, Bigat Z, Dikici M B. Experiences with microsurgical tissue transfers in elderly patients.  Microsurgery. 2005;  25(5) 390-395
  • 9 Goldman L, Caldera D L, Nussbaum S R et al.. Multifactorial index of cardiac risk in noncardiac surgical procedures.  N Engl J Med. 1977;  297(16) 845-850
  • 10 Lee T H, Marcantonio E R, Mangione C M et al.. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery.  Circulation. 1999;  100(10) 1043-1049
  • 11 Amar D, Roistacher N, Burt M, Reinsel R A, Ginsberg R J, Wilson R S. Clinical and echocardiographic correlates of symptomatic tachydysrhythmias after noncardiac thoracic surgery.  Chest. 1995;  108(2) 349-354
  • 12 Sinclair A J, Robert I E, Croxson S CM. Mortality in older people with diabetes mellitus.  Diabet Med. 1997;  14(8) 639-647
  • 13 Polanczyk C A, Goldman L, Marcantonio E R, Orav E J, Lee T H. Supraventricular arrhythmia in patients having noncardiac surgery: clinical correlates and effect on length of stay.  Ann Intern Med. 1998;  129(4) 279-285
  • 14 Lakatta E G. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part III: cellular and molecular clues to heart and arterial aging.  Circulation. 2003;  107(3) 490-497
  • 15 Lakatta E G, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part II: the aging heart in health: links to heart disease.  Circulation. 2003;  107(2) 346-354
  • 16 Chan E D, Welsh C H. Geriatric respiratory medicine.  Chest. 1998;  114(6) 1704-1733
  • 17 Varanasi R V, Varanasi S C, Howell C D. Liver diseases.  Clin Geriatr Med. 1999;  15(3) 559-570
  • 18 Dunnill M S, Halley W. Some observations on the quantitative anatomy of the kidney.  J Pathol. 1973;  110(2) 113-121
  • 19 Lindeman R D. Overview: renal physiology and pathophysiology of aging.  Am J Kidney Dis. 1990;  16(4) 275-282
  • 20 Kaysen G A, Myers B D. The aging kidney.  Clin Geriatr Med. 1985;  1(1) 207-222
  • 21 Perry III H M. The endocrinology of aging.  Clin Chem. 1999;  45(8 Pt 2) 1369-1376
  • 22 Chiovato L, Mariotti S, Pinchera A. Thyroid diseases in the elderly.  Baillieres Clin Endocrinol Metab. 1997;  11(2) 251-270
  • 23 Roberts-Thomson I C, Whittingham S, Youngchaiyud U, Mackay I R. Ageing, immune response, and mortality.  Lancet. 1974;  2(7877) 368-370
  • 24 Luckey A E, Parsa C J. Fluid and electrolytes in the aged.  Arch Surg. 2003;  138(10) 1055-1060
  • 25 Beck L H. Perioperative renal, fluid, and electrolyte management.  Clin Geriatr Med. 1990;  6(3) 557-569
  • 26 Goodnough L T, Brecher M E, Kanter M H, AuBuchon J P. Transfusion medicine. First of two parts—blood transfusion.  N Engl J Med. 1999;  340(6) 438-447
  • 27 Carson J L, Duff A, Poses R M et al.. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity.  Lancet. 1996;  348(9034) 1055-1060
  • 28 Hogue Jr C W, Goodnough L T, Monk T G. Perioperative myocardial ischemic episodes are related to hematocrit level in patients undergoing radical prostatectomy.  Transfusion. 1998;  38(10) 924-931
  • 29 Mathes D D, Conaway M R, Ross W T. Ambulatory surgery: room air versus nasal cannula oxygen during transport after general anesthesia.  Anesth Analg. 2001;  93(4) 917-921
  • 30 Jin F, Chung F. Minimizing perioperative adverse events in the elderly.  Br J Anaesth. 2001;  87(4) 608-624
  • 31 Collins K J. Effects of cold on old people.  Br J Hosp Med. 1987;  38(6) 506-508, 510–512, 514
  • 32 Vaughan M S, Vaughan R W, Cork R C. Postoperative hypothermia in adults: relationship of age, anesthesia, and shivering to rewarming.  Anesth Analg. 1981;  60(10) 746-751
  • 33 Frank S M, Higgins M S, Breslow M J et al.. The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia. A randomized clinical trial.  Anesthesiology. 1995;  82(1) 83-93
  • 34 Polanczyk C A, Goldman L, Marcantonio E R, Orav E J, Lee T H. Supraventricular arrhythmia in patients having noncardiac surgery: clinical correlates and effect on length of stay.  Ann Intern Med. 1998;  129(4) 279-285
  • 35 Amar D, Zhang H, Leung D HY, Roistacher N, Kadish A H. Older age is the strongest predictor of postoperative atrial fibrillation.  Anesthesiology. 2002;  96(2) 352-356

O. Koray CoşkunfıratM.D. 

Associate Professor, Department of Plastic and Reconstructive Surgery

Akdeniz University School of Medicine, Dumlupinar Bulvari, 07059 Antalya, Turkey

Email: coskunfirat@superonline.com