Is craniofacial resection in elderly patients too risky?—a 12-year review from two centres

Background: Craniofacial resection (CFR) is a well-established surgical treatment for malignant sinonasal tumours. While advanced age has traditionally been considered a risk factor for postoperative complications, recent advancements in surgical techniques, including hybrid and endoscopic approaches, may have reduced these risks. This study aims to assess the safety of CFR in elderly patients (≥70 years) by comparing their complication rates with younger patients. Methods: This retrospective cohort study analysed CFR cases at two hospitals in Melbourne, Australia, between 2011 and 2023. Patients were stratified into two age groups: <70 and ≥70 years. The primary outcome was the complication rate, including cerebrospinal fluid (CSF) leaks, meningitis, pneumocephalus, intracranial hematoma, cardiovascular events, pulmonary complications, delirium, venous thromboembolism, blindness, and infections. The secondary outcomes included perioperative mortality and length of hospital stay. Results: Of 83 patients who underwent CFR, 73 met inclusion criteria (<70 years, 45; ≥70 years, 28). The complication rate was 26.7% in younger patients and 25.0% in elderly patients [P=0.875; odds ratio (OR) =1.09; 95% confidence interval (CI): 0.37–3.21]. No inpatient or 28-day postoperative deaths were observed in either group. The median hospital stay was 12 days [interquartile range (IQR), 10–21 days days] for younger patients and 11 days (IQR, 9–15.5 days) for elderly patients (P=0.037; OR =1.717; CI: 0.613–4.802). Conclusions: This study did not demonstrate an increased rate of complications in patients aged ≥70 years undergoing CFR, when compared with those aged <70 years. Advanced age alone should not be a contraindication to undergo CFR and instead the decision should be made with multidisciplinary consideration of individual patient factors, health status, patient preferences, and medical comorbidities.