Predictors of postoperative complications, prolonged length of hospital stay, and short-term mortality in elderly patients with malignant head and neck neoplasm.

PURPOSE: To identify and assess predictors of short-term outcomes and a prolonged length of hospital stay after head and neck cancer surgery in older-old and oldest-old patients. PROCEDURES: Patients aged ≥75 years with head and neck cancer undergoing surgery at the Brazilian National Cancer Institute from January to December 2011 were assessed regarding postoperative complications, mortality, and length of hospital stay. RESULTS: Over the study period, 67 patients with head and neck cancer underwent surgery, 44.8% of whom developed complications within 30 days of surgery, surgical site and respiratory infections (29.9 and 20.9%, respectively) being the most common. The mean length of hospital stay was 7 days (range: 2-26). In multivariate analysis, previous radiotherapy, dependence in instrumental activities of daily living, and low serum hemoglobin (≤13.2 g/dl) were predictors of complications. In addition, the presence of at least 1 clinical or surgical complication, smoking, and an arm circumference ≤25 cm were independent predictors of a prolonged length of hospital stay. CONCLUSIONS: Complications after head and neck cancer surgery in the elderly are common and related to the prolonged length of hospital stay, both being influenced by previous radiotherapy, smoking, functional dependence in instrumental activities of daily living, and nutritional conditions. Such predictors should be considered in a preoperative assessment of elderly patients as these are modifiable risk factors.

Use of prototyping in preoperative planning for patients with head and neck tumors.

BACKGROUND: Prototyping technologies for reconstructions consist of obtaining a 3-dimensional model of the object of interest. Solid models are constructed by the deposition of materials in successive layers. The purpose of this study was to perform a double-blind, randomized, prospective study to evaluate the efficacy of prototype use in head and neck surgeries. METHODS: Thirty-seven cases were randomized into prototype and nonprototype groups. The following factors were recorded: the time of plate and locking screw apposition, flap size, time for reconstruction, and an aesthetic evaluation. RESULTS: The prototype group exhibited a reduced surgical time (43.7 minutes vs 127.7 minutes, respectively; p = .001), a tendency to reduce the size of the bone flap taken for reconstruction, and better aesthetic results than the group that was not prototyped. CONCLUSION: The use of prototyping demonstrated a trend toward a reduced surgical time, smaller bone flaps, and better aesthetic results.