Association of Preoperative Depression and Clinical Outcomes After Head and Neck Free Flap Reconstruction

Sunday, October 12, 2025

10:06 AM - 10:12 AM EDT

Location: 127

Disclosure(s):

Sindhura Sridhar, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Daniel Roy Sadek Habib, BA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Michael C. Topf, MD, MSCI:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Comorbid depression is a significant negative predictor of survival in patients with head and neck cancer (HNC). Prior studies have shown a prevalence rate of up to 40.1%; however, depression is often underdiagnosed in this patient population.

Methods: We conducted a retrospective review of patients who underwent free flap reconstruction for HNC at our institution (January 2019–December 2023). The primary outcome was overall survival (OS). Secondary outcomes included length of hospital stay, discharge destination, and 30-day readmission. Log-rank, Kaplan-Meier analyses, and multivariate Cox proportional hazards models estimated the effect of preoperative depression on OS. Multivariate regression models examined the association of preoperative depression with secondary outcomes.

Results: 709 patients were included. Preoperative depression was present in 53 patients (7.5%) and 40 patients (5.6%) were on preoperative SSRI/SNRIs. There was no difference in OS in depressed patients compared to non-depressed patients (p = 0.6). Patients on preoperative SSRI/SNRI had worse OS (p = 0.02). However, preoperative SSRI/SNRI was not independently associated with worse OS on Cox proportional hazards model (adjusted hazards ratio 1.68, 95% CI: 0.97-2.91). Preoperative SSRI/SNRI use was independently associated with increased length of stay (adjusted odds ratio 220.19, 95% CI 26.08-1859.21). There were no associations of preoperative depression or SSRI/SNRI use with discharge destination or 30-day readmission rates.

Conclusions: Preoperative SSRI/SNRI use is associated with greater length of stay after free flap reconstruction. Preoperative depression was present at one-fifth the estimated rate in our patients, potentially highlighting the need for improved screening at our institution.

Presenting Author(s)

Sindhura Sridhar, BS

Medical Student
Texas A&M School of Medicine
Austin, TX, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

DL

Daniel P. Larson, BS

Vanderbilt University School of Medicine, Tennessee, United States

Disclosure information not submitted.
HS

Heezy Suh, BA

Vanderbilt University School of Medicine, United States

Disclosure information not submitted.
Daniel Roy Sadek Habib, BA

Fourth-Year Medical Student
Vanderbilt University School of Medicine
Nashville, Tennessee, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
KV

Kelly L. Vittetoe, MD

Resident MD
Vanderbilt University
Nashville, Tennessee, United States

Disclosure information not submitted.
DS

Donald Sengstack, MS

Vanderbilt University Medical Center, United States

Disclosure information not submitted.
MT

Michael C. Topf, MD, MSCI

Associate Professor of Otolaryngology - Head and Neck Surgery
Vanderbilt University Medical Center- Department of Otolaryngology
Nashville, TN, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

Melanie D. Hicks, MD

Assistant Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Disclosure information not submitted.