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

Abstract 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.