Mental Health Disorders and Pain in Patients Undergoing Head and Neck Free Flap Surgery.

Objective: Determine relationships between pain and mental health disorders (MHDs) in patients undergoing microvascular free flap reconstruction for head and neck cancer (HNC).

Study design: Retrospective cohort.

Setting: Tertiary Care Institution in the Southeastern United States.

Methods: Clinical data were manually abstracted from digital health records to obtain demographic, MHD, clinical outcomes, and pain data for HNC patients who underwent free flap reconstruction from 2017 to 2023. Univariate and multivariable regression analyses were performed to delineate relationships between MHDs and postoperative pain.

Results: The study cohort comprised 283 patients. Ninety-four patients (33%) had preoperative MHDs, which were more common in women (42% vs 30%, P = .04) and in patients with chronic pain (53% vs 32%, P < .01). Preoperative opioid use (P = .03) and preoperative MHD (P = .03) were predictive of higher postoperative day (POD) 5 pain score. Thirty-three patients (11.7%) were diagnosed with a new MHD postoperatively, and 58 patients (20.5%) were started on a new long-term psychiatric medication postoperatively. POD1 pain score was predictive of the need for a new psychiatric medication postoperatively (odds ratio [OR] = 1.27, 95% CI: 1.05-1.56, P = .02).

Conclusion: Postoperative pain and MHDs are independently predictive of one another in patients with HNC undergoing microvascular free flap reconstruction. Higher POD5 pain is predicted by the presence of preoperative MHD, and the need for a new psychiatric medication postoperatively is predicted by higher POD1 pain. HNC surgeons should align themselves with psychiatrists, social workers, and other allied fields to meet the complex mental health needs of their patients both preoperatively and postoperatively.