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Comment & Response
April 23, 2020

The Importance of Including Otolaryngologists With Geriatric-Specific Training in Research on Older Patients Undergoing Head and Neck Surgery—Reply

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
  • 2West Virginia University, Morgantown
JAMA Otolaryngol Head Neck Surg. Published online April 23, 2020. doi:10.1001/jamaoto.2020.0379

In Reply Thank you for sharing with us Dr Parham’s letter to the editor regarding our recent publication, “Complications, Mortality, and Functional Decline in Patients 80 Years or Older Undergoing Major Head and Neck Ablation and Reconstruction.”1 We are appreciative of the comments in the letter and agree with Dr Parham’s assertion that cognitive functional decline and postoperative delirium are common and major complications in this vulnerable population. The objective of the study was to combine the experience of multiple academic institutions to identify factors associated with postoperative complications, mortality and functional decline to assist in preoperative counseling. While we feel this publication provides new and important data regarding said outcomes, we also acknowledge its limitations. If impaired sensorium was present preoperatively, this was included as part of the patient’s Modified Frailty Index assessment. Given the constraints of a retrospective cohort study design across 17 institutions, the limited and inaccurate documentation of postoperative delirium, and the lack of objective measurements of cognitive function perioperatively, we were unfortunately unable to include these as outcomes in the study. We are supportive of the proposal to increase the frequency and quality of research investigations for this unique growing population, and acknowledge the need to factor in the role of delirium and dementia in future studies.

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