Importance: Not much is known about how pre-operative psychosocial factors affect head and neck free flap outcomes.
Objective: To determine if a patient’s pre-operative self-perception and quality of life affect postoperative complications and hospital length of stay after free flap surgery
Design, Setting, and Participants: This was a prospective cohort study. Patients who underwent free flap surgery at an academic tertiary care center between January to September 2021 were asked to fill out the Rosenberg Self Esteem Scale and the Short Form 36 before surgery. A chart review of their medical records was then performed. Analysis of the data was performed using the Fisher exact test and Mann-Whitney on STATA 15.
Exposures: Free Flap
Main Outcomes and Measures: Rosenberg Self Esteem Scale score, Short Form 36 subset scores, demographic characteristics, postoperative complications, length of stay
Results: Thirty patients (21 male, 9 female, mean [SD; range] age: 59.5 [14.5; 23.1 - 84.9]) who underwent free flap surgery agreed to participate in the study. Sixteen patients (53.5%) were Caucasian and fourteen patients (46.7%) had preferred provider organization (PPO). Insurance status did not affect postoperative complications. The most common indication for surgery was malignancy (93.3%). Nine patients (30%) had one or multiple post-operative complications. Postoperative complications included 2 hematoma (6.7%), 2 free flap failure (6.7%), 1 wound dehiscence (3.3%), 4 salivary fistulas (13.3%), and 2 aspiration pneumonia (6.7%). There were no mortalities. The mean physical functioning subscore [SD; range] and social functioning subscore of the SF-36 were 86 [20.6, 10-100] and 76 [25.1, 12.5-100]. The mean Rosenberg Self Esteem Scale score was 24.4 [4.6, 13 – 30]. Improved physical functioning score and social functioning score were associated with fewer overall post-operative complications (p = 0.029 and 0.030, respectively), but were not correlated with length of stay. Mean self-esteem score was not associated with postoperative complication rates.
Conclusions and Relevance: In this study, patients who perceived that they could do more physically and had fewer social limitations had fewer postoperative complications. It is important to continue to explore how preoperative quality of life and other psychosocial factors can affect surgical outcomes as they can affect the patients’ postoperative course.