Fancy T, Huang AT, Kass JI, et al. - Since data regarding outcomes after major head and neck ablation and reconstruction in the growing geriatric population (specifically ≥ 80 years of age) are insufficient, researchers identified patient and surgical factors correlated with 30-day postoperative complications, 90-day mortality, and 90-day functional decline, and ascertained if a relationship exists between the type of reconstructive procedure and outcome, as well as designed a preoperative risk stratification system for these outcomes. Among 376 individuals [median age was 83 years (range, 80-98 years)] involved in this retrospective, multi-institutional cohort study, 281 had free-flap reconstruction. Age of at least 85 years, moderate or severe comorbidities, BMI of less than 25, high frailty, duration of surgery, flap failure, additional operations, and surgery of the maxilla, oral cavity, or oropharynx were variables linked to worse outcomes. Findings suggested no independent association of free flap and bony reconstruction with worse outcomes. To assist in preoperative patient counseling and surgical planning, a novel risk classification system based on age, BMI, comorbidity, and frailty is provided.