Time under general anesthesia associated with postoperative complications in head and neck surgery

July 18, 2005

CHICAGO - The amount of time a patient is under general anesthesia during major head and neck surgery, not their age, was associated with postoperative complications, according to an article in the July issue of Archives of Otolaryngology - Head & Neck Surgery, one of the JAMA/Archives journals.

The elderly population in the United States is expected to rise from 34.7 million in 2000 to 69.4 million persons older than 65 years in 2030, according to background information in the article. This may result in increased numbers of elderly patients requiring major head and neck surgical procedures. As age has received increased attention as a predictive factor for postoperative complications, so has the question of the appropriateness of candidates for surgery based on age.

Marina Boruk, M.D., from the State University of New York Downstate Medical Center, Brooklyn, and colleagues, conducted a retrospective study of medical records, between January 1999 and January 2004, to determine if age alone is a predictor of outcomes for major head and neck surgery. The review included 157 cases of patients who had undergone a major head and neck surgical procedure, of whom 31 (20 percent) were 70 years or older. The age of patients ranged from nine to 95 years, with an average of 56.1 years. Fifty-nine percent (92) were men and 41 percent (65) were women.

Patient's age alone was not found to be a predictive indicator of outcomes for major head and neck surgery. Time under general anesthesia (TUGA) was the only factor found to be consistently related to surgical complications and length of hospital stay. TUGA ranged from 75 to 1,160 minutes, with a median (middle value) of 240 minutes. The odds of a patient having a complication increased by 0.6 percent with every minute of anesthesia, therefore the odds of having a major complication increased by 36 percent every hour under anesthesia. The odds of having any complication (major or minor) increased by 18 to 36 percent for every hour under anesthesia, depending on the analysis. Being 70 years or older was not associated with complications or length of stay (LOS) in any of the researchers' analyses. The median length of stay for patients was three days in males and two days in females.

"Our findings support the growing acceptance that age, in and of itself, is not a risk factor for major head and neck surgery. ... Care should be taken to carefully control preoperative comorbid conditions and offer the appropriate medical care," the authors write. "TUGA showed a statistically significant relationship with complication rate and hospital LOS in multivariate analyses. This relationship held true for all age groups."
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(Arch Otolaryngol Head Neck Surg. 2005; 131:605-609. Available pre-embargo to the media at www.jamamedia.org.)

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or email mediarelations@jama-archives.org.

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