The Impact of Neighborhood Socioeconomic Deprivation on Pediatric Head and Neck Free Flap Reconstruction

BACKGROUND: Recent studies have identified various socioeconomic disparities in postoperative outcomes among adults undergoing head and neck (H&N) microsurgical reconstruction (1, 2). This dynamic has yet to be rigorously evaluated within the pediatric context. This study aimed to measure the impact of socioeconomic factors on outcomes of H&N free tissue transfer in a pediatric population. METHODS: A retrospective review was conducted of children who underwent H&N free tissue transfer (FTT) at a tertiary children’s hospital from May 2007 to May 2024. Patients were grouped into cohorts according to the Area Deprivation Index (ADI) associated with their household zip code. ADI is a composite measure designed to quantify the geographic distribution of socioeconomic deprivation on a 10-point scale. Cohorts were defined as low deprivation for ADI 1-5 and high deprivation for ADI 6-10. Patients were further characterized by race, insurance status, and primary diagnosis. Outcomes included flap failure, flap dehiscence, flap revision, and duration of hospitalization. RESULTS: A total of 59 patients, undergoing 75 FTTs, met inclusion criteria, among whom 43.1% were considered low deprivation and 56.9% high deprivation. Mean age at surgery was 11.8 ± 4.8 years. Overall flap survival was 97.3%. Rates of flap failure, unanticipated revision, and readmission did not differ between cohorts. However, flap dehiscence was significantly more likely among high deprivation patients (25.6% vs. 6.2%, p=0.034). Furthermore, every 1 point increase in ADI over 5 was associated with a 7.8% increase in the odds of flap dehiscence (p<0.05). DISCUSSION: Neighborhood socioeconomic deprivation was independently predictive of flap dehiscence among children undergoing H&N FTT, but was not associated with flap failure, flap revisions, or 30-day readmissions. This finding underscores the broader impact of socioeconomic factors on pediatric health outcomes, particularly surgical wound healing. Poor nutrition, lower health literacy, and limited resources may drive this dynamic within our study population. Integrating socioeconomic considerations into pediatric microsurgical care may optimize outcomes for vulnerable patients after head and neck free flap reconstruction.