Anesthetic Duration, Not Age, Predicts Head And Neck Complications

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Anesthetic Duration, Not Age, Predicts Head And Neck Complications

By , MedPage Today Staff Writer

Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of

Pennsylvania School of Medicine.

July 20, 2005

Review

NEW YORK, July 20-The time spent under general anesthesia -- not the

age of the patient -- is a significant predictor of complications after

major head and neck surgery, according to investigators here.

" Age, in and of itself, is not a risk factor for major head and neck

surgery, " Marina Boruk, M.D., of the Downstate Medical Center in

Brooklyn and colleagues reported in the July issue of the Archives of

Otolaryngology -- Head and Neck Surgery.

On the other hand, time under general anesthetic -- regardless of age

-- was the only factor consistently and significantly related to

complications (p<0.006) and to length of stay in hospital (p<0.001),

they reported.

The finding has implications for the care of elderly people, who are

often thought to be poor candidates for surgery because of their age,

Dr. Boruk said. The risk is that physicians will opt for palliative

rather than curative care if they fear older patients are a poor

surgical risk.

To see whether that fear is justified, Dr. Boruk and colleagues carried

out a retrospective cohort study, using the medical records at their

center over a four-year period, from January 1999 to January 2004.

The final review found 157 patients who had undergone a major head and

neck surgical procedure. Thirty-one (20%) were 70 years or older,

although the ages ranged from nine to 95 years.

In a multivariate analysis, major complications -- including pneumonia,

myocardial infarction, delirium, and MRSA-tracheitis -- were correlated

with time in minutes under general anesthetic with an odds ratio of

1.006 -- meaning that the risk of major complication increased by 0.6%

for every minute of anesthesia.

Put another way, every additional 60 minutes of anesthesia was

associated with a 36% increased risk of major complication, the

researchers found.

A similar analysis for all complications, both major and minor, showed

that every additional hour of anesthetic meant an 18% increase in risk.

Time under general anesthetic ranged from 75 to 1,160 minutes, with a

median of 240 minutes. Comorbidity was related to outcome but the

effect was smaller than for time under general anesthesia.

The study was not initially designed to analyze the risk of time under

general anesthetic, and so did not control for case type. On the other

hand, the authors said, " we assume that major head and neck surgical

procedures inherently place similar stresses on the body, " unlike other

forms of surgery.

The elderly population in the U.S. -- people older than 65 -- is

expected to rise from 34.7 million in 2000 to 69.4 million in 2030, the

researchers noted, " and with it, the number of elderly patients

presenting for surgery. "

Decisions on their care should not be based on " incorrect medical

prejudices of advanced age, " Dr. Boruk and colleagues argued. Instead,

physicians should take into account such things as physiologic age and

comorbid conditions, as well as the probable length of time under

anesthesia.

It remains possible that age is related to complications, the

researchers note; there were only 10 major complications and 57

complications in total among 157 cases. " Therefore, there may not have

been enough cases to prove … there is no correlation between age and

complication rate, " they say.

Primary source: Archives of Otolaryngology-Head & Neck Surgery

Source reference:

Boruk, M et al. Age as a Prognostic Factor for Complications of Major

Head and Neck Surgery. Arch Otolaryngol Head Neck Surg.

2005;131:605-609

http://www.medpagetoday.com/Surgery/GeneralSurgery/tb1/1395