# Pushing the boundaries - perioperative risk assessment and short-term surgical outcomes in octogenarian patients with head and neck cancer: comparison with non-oncological elderlies

## TL;DR

This study compares surgical risks and outcomes in elderly patients with and without head and neck cancer to guide better preoperative care.

## Contribution

The study identifies distinct risk patterns between oncological and non-oncological elderly patients using specific risk scales.

## Key findings

- Oncological patients had higher comorbidity and surgical risk scores compared to non-oncological patients.
- Caprini scores best predicted complications in non-oncological patients, while comorbidity index was key in oncological patients.
- Oncological status was independently linked to increased complication risk in elderly surgical patients.

## Abstract

There is an expanding body of research focuses on the clinical management of patients aged eighty and above. It remains uncertain whether therapeutic approaches for head and neck cancer in this demographic require a higher acceptance of perioperative risk compared to age-matched non-oncological individuals. This study aimed to characterize perioperative risk and early postoperative outcomes in octogenarian patients with and without head and neck cancer, and to explore how different geriatric and surgical risk scales perform in predicting adverse events in these two subgroups.

This retrospective analysis encompassed data from eight university-affiliated otorhinolaryngology departments in Poland, covering the period from September 2023 to August 2024.

The oncological cohort exhibited a markedly higher prevalence of risk factors: male sex, smoking history, and previous malignancies compared with non-oncological cohort. Patients with head and neck cancer also demonstrated substantially elevated results on the Caprini, Charlson Comorbidity Index, American Society of Anesthesiologists Physical Status Classification, and Venous Thromboembolism scales, indicating increased multimorbidity and surgical risk. Although hospitalization durations were numerically longer for oncological cases, this difference was not statistically significant, and both groups showed similar functional independence and frailty scores. Logistic regression analyses highlighted that complication risk in non-oncological group was best predicted by Caprini scores, whereas the comorbidity index was the most informative predictor in oncological group. Cross-applied models failed to reach significance, confirming distinct risk patterns. Overall, sixteen percent of patients experienced at least one major complication, with oncological status independently associated with increased risk.

These findings demonstrate the multifactorial landscape of perioperative risk among the oldest surgical patients and provide quantitative evidence to support population-specific preoperative strategies in geriatric oncology.