Association of Preoperative Depression and Clinical Outcomes After Head and Neck Free Flap Reconstruction

OBJECTIVE: Comorbid depression is a significant negative predictor of survival in patients with head and neck cancer (HNC). Prior studies have shown a prevalence of up to 40.1%; however, depression is often underdiagnosed in this patient population. STUDY DESIGN: Retrospective cohort. SETTING: Single-institution database. METHODS: Patients who underwent free flap reconstruction for HNC at our institution (January 2019-December 2023) were retrospectively reviewed. The primary outcome was overall survival (OS). Secondary outcomes included length of stay, discharge disposition, 30-day readmissions, and postoperative radiotherapy (PORT) delay. Kaplan-Meier and multivariate Cox proportional hazards models estimated the effect of preoperative depression on OS. Multivariate regression models examined the association of preoperative depression with secondary outcomes. RESULTS: 645 patients were included. Preoperative depression was present in 158 patients (24%) and 150 patients (23%) were on preoperative antidepressants. There was no difference in OS in depressed patients compared to nondepressed patients (adjusted hazard ratio [aHR] 1.07, 95% confidence interval [CI] 0.76-1.51). Preoperative antidepressant use was independently associated with discharge to rehabilitation or skilled nursing facilities compared to discharge home (adjusted odds ratio [aOR] 1.82, 95% CI 1.07-3.06). There were no associations of preoperative depression with length of stay, 30-day readmission rates, or PORT delay. CONCLUSION: Preoperative antidepressant use is associated with greater likelihood of discharge to rehabilitation facilities after free flap reconstruction. Preoperative depression was present at one-half the estimated rate in our patients, highlighting the need for improved preoperative screening and intervention.