Mental Health Risk Factors for Postoperative Pain in Head and Neck Free Flap Reconstruction Patients

OBJECTIVE: Head and neck cancer (HNC) surgery is associated with postoperative pain and comorbid mental health disorders (MHDs). This study assessed predictors of postoperative pain and inpatient pain service consultation following free flap reconstruction (FFR). STUDY DESIGN: Retrospective cohort. SETTING: Single-institution database. METHODS: Multivariable linear and logistic regressions identified predictors of postoperative day 5 (POD5) pain scores (0-10) and pain consultation, respectively. Propensity-matched analyses compared pain trajectories by MHD (depression or anxiety) and pain consultation. RESULTS: The cohort included 645 FFR patients. Higher POD5 pain was associated with MHD (β: 0.43; 95% CI: 0.03, 0.84), currently smoking (β: 0.58; 95% CI: 0.14, 1.03), being separated/divorced versus single (β: 0.71; 95% CI: 0.03, 1.39), osteocutaneous radial forearm free flap (OCRFFF) versus fasciocutaneous radial forearm free flap (RFFF) (β: 0.54; 95% CI: 0.02, 1.05), laryngeal site versus oral cavity (β: 0.59; 95% CI: 0.06, 1.13; P = .029), and non-oncologic indication (β: 0.86; 95% CI: 0.06, 1.67; P = .036). Pain consultation was associated with MHD (adjusted odds ratio [aOR]: 1.99; 95% CI: 1.13-3.52), preoperative narcotic use (aOR: 3.20; 95% CI: 1.77-5.79), OCRFFF (aOR: 3.42; 95% CI: 1.53-7.66), and private insurance (aOR: 3.09; 95% CI: 1.46-6.58). Among propensity-matched patients with an MHD, pain scores were not significantly different by pain consultation, while non-MHD patients with pain consultation reported higher pain across POD1-5 (P < .01). CONCLUSION: Psychosocial and clinical factors such as MHD diagnosis were independently associated with pain scores and pain service consultation after FFR. Patients with an MHD are particularly vulnerable. Identifying risk factors preoperatively may guide personalized perioperative pain management strategies.