Associations Between Preexisting Depression and Anxiety and Postoperative Outcomes Among Medicare Beneficiaries Undergoing Head and Neck Cancer Surgery

INTRODUCTION: Depression and anxiety are common in patients with head and neck cancer (HNC), but their impacts on postoperative outcomes after major HNC surgery are not well defined. We evaluated whether preexisting, clinically diagnosed depression or anxiety independently predicted short-term postoperative outcomes among adults undergoing HNC resection. METHODS: We performed a retrospective cohort study using 100% Medicare Standard Analytic Files from 2016 to 2023. Beneficiaries with HNC who underwent oncologic head and neck resection were identified using ICD-10-CM/PCS codes. Preexisting depression and anxiety were defined using Chronic Conditions Warehouse algorithms (≥ 1 inpatient or ≥ 2 outpatient claims in the year before surgery). Outcomes included length of stay (LOS), extended LOS (> 75th percentile), in-hospital complications, and 30- and 90-day readmission and mortality. LOS was modeled using truncated negative binomial regression; binary outcomes were modeled with multivariable logistic regression adjusting for demographics, comorbidities, tumor site, tobacco use, hospital teaching status, procedure complexity, and co-occurring depression or anxiety. RESULTS: Among 45 293 patients (median age 72 years), 6.6% had preexisting depression and 7.6% had preexisting anxiety. Depression was associated with a longer LOS (incidence rate ratio IRR 1.06, 95% CI 1.07-1.13), higher 30-day mortality (odds ratio OR 1.28, 95% CI 1.06-1.54), 90-day mortality (OR 1.22, 95% CI 1.07-1.39), and higher 30- and 90-day readmissions (OR 1.20, 95% CI 1.07-1.34; OR 1.27, 95% CI 1.15-1.39), but not with in-hospital complications. Anxiety was similarly associated with longer LOS (IRR 1.10, 95% CI 1.07-1.13), extended LOS (OR 1.33, 95% CI 1.20-1.48), in-hospital complications (OR 1.18, 95% CI 1.06-1.30), and higher 30- and 90-day mortality (OR 1.38, 95% CI 1.16-1.65; OR 1.33, 95% CI 1.18-1.50), but not readmissions. CONCLUSIONS: Among Medicare beneficiaries undergoing HNC surgery, preexisting depression or anxiety are independent markers of increased postoperative risk. Routine mental health screening and targeted perioperative support may be important components of high-quality head and neck oncologic care.