INTRODUCTION
With the US population aging, more elderly patients are being diagnosed with head and neck cancers. Comorbidities are more common in elderly patients, and there are concerns about the morbidity of lengthy surgery, such as with microvascular head and neck reconstruction, and its impact on the elderly patient. The post-hospitalization needs and disposition of this patient population, for example discharge to home versus a skilled nursing facility, has not been studied. The purpose of this study is to investigate whether or not the elderly, as compared to younger patients, are more likely to be discharged to a nursing or other care facility as opposed to returning home following microvascular reconstruction of the head and neck.

METHODS
The medical records of 450 patients undergoing head and neck microvascular reconstruction were reviewed. The patients’ age at the time of procedure, primary diagnosis, site of tumor involvement, revision versus primary procedure, American Society of Anesthesiologists (ASA) score, length of postoperative stay, and disposition following hospitalization were analyzed. Associations between variables were analyzed using the paired t, chi-square, Fisher exact, and Kruskal-Wallis tests to determine odds ratios (OR) on a multinomial regression model.

RESULTS
The average age of participants was 59.1; 278 of the 450 were under the age of 65. The median length of stay was 10 days. Most patients were discharged home with or without home health services, n = 386 (85.8%). Of those discharged home, 267 (69.2%) were under 65 years old, the remaining 65 and over (p < 0.0001). The average age of those discharged home was 57.5; discharge to home was the reference for comparison and odds ratio (OR) calculation. For those discharged to a skilled nursing facility (SNF), average age was 67.1 (OR 5.5, p=0.0005). Average age of those discharged to a long-term acute care (LTAC) facility was 71.5 (OR 9.2, p=0.0024). With each year older a patient is, the odds of going to a nursing facility are 5.5% higher than going home. When controlling for the ASA score, the OR were even higher and remained significant for discharge to SNF and LTAC. Length of stay also impacted the disposition. The average LOS for those under 65 was 12.4 (3-75, SD=9.3), 65 and over 16.7 (3-80, SD=13.6). Primary versus salvage procedures as well as the number of tumor sites involved did not affect the disposition with statistical significance.

CONCLUSIONS
Previous research has shown that the elderly patient is just as likely to survive a major surgical procedure such as head and neck reconstruction as one under age 65. However this study demonstrates that older patients are less likely to be discharged home at the end of the hospitalization. Age, independent of comorbidities as measured by the ASA score, as well as the length of stay are risk factors for discharge to a nursing or other care facility as opposed to home following microvascular reconstruction.