Postoperative Loss of Independence in Geriatric Head and Neck Cancer Patients: A Database Study.

[OBJECTIVE] Loss of independence (LOI) is a key concern after head and neck cancer (HNC) surgery, yet its predictors remain unclear. This study aimed to identify perioperative and postoperative factors linked to LOI in geriatric HNC patients.

[METHODS] We conducted a retrospective cohort study using 2021-2023 ACS-NSQIP data. Patients aged ≥ 75 years who underwent HNC surgery with preoperative and discharge functional status data were included. The primary outcome was LOI, defined as a decline in functional status at discharge compared to baseline. Logistic regression was used to identify independent predictors of LOI.

[RESULTS] Among 4290 patients, 471 (10.9%) experienced LOI. LOI was associated with diabetes (p = 0.001), metastatic disease (p = 0.037), smoking (p = 0.001), dementia (p < 0.0001), and falling within 6 months (p < 0.0001). Longer operative times (mean 320.89 vs. 63.68 min, p < 0.0001) and hospital stays ≥ 2 days (p < 0.0001) were associated with LOI. Overweight and obese patients had lower odds of LOI (OR: 0.75, 95% CI: [0.57, 0.98]; OR: 0.70, 95% CI: [0.52, 0.95]). Operative time > 5 h (OR: 1.66, 95% CI: [1.1-2.35]) and length of stay ≥ 2 days (OR: 2.13, 95% CI: [1.48-3.07]) were associated with LOI. Surgical procedures linked to higher odds included free flap (OR: 1.89, 95% CI: [1.70-8.39]), laryngeal resection (OR: 3.99, 95% CI: [1.40-11.34]), neck dissection (OR: 2.78, 95% CI: [1.29-5.99]), regional flap (OR: 3.85, 95% CI: [1.80-8.27]), and total glossectomy (OR: 2.65, 95% CI: [1.02-6.86]).

[CONCLUSION] Identifying patients at risk for LOI may guide surgical decision-making in older adults undergoing HNC surgery.