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Scientific Oral Presentations

Head and Neck Surgery

Session: Scientific Oral Presentations 6 - Head and Neck Surgery

Psychiatric Comorbidities and Pain in Patients Undergoing Head and Neck Free Flap Surgery

Monday, September 30, 2024
2:48 PM – 2:54 PM EDT
Location: MBCC, 208
Disclosure(s):
Marina Aweeda, BS:

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

Christopher Naranjo, BS:

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

Wenda Ye, MD:

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

Alexander Langerman, MD:

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.

James l. Netterville, MD:

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

Eben L. Rosenthal, MD:

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

Robert J. Sinard, MD:

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

Sarah L. Rohde, MD:

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

Introduction: Patients with head and neck cancer are disproportionately affected by psychiatric comorbidities, which may impact postoperative pain management and clinical outcomes.

Methods: A retrospective chart review was performed to collect demographics, psychiatric comorbidities, and postoperative pain data on patients who underwent free flap reconstruction at a single institution from 2017-2023. Patients were sorted into groups based on presence of preoperative psychiatric diagnosis (depression, anxiety, bipolar disorder, PTSD, panic disorder).

Results: A total of 243 patients were identified, with a male majority (68.7%). Of those, 80 patients (32.9%) had a preoperative psychiatric diagnosis, 83.8% of whom were taking medication for their diagnosis. The most common diagnosis was depression (71.3%), followed by anxiety (52.5%). A preoperative psychiatric diagnosis was more common in women than men (50% vs 28%, p < 0.01). Sixteen patients (20%) in the Psych-Dx group required postoperative pain consultation compared to 10 patients (6.1%) in the No-Psych-Dx group (p < 0.01). Mean postoperative day 1 (POD1) pain score for the Psych-Dx group was 4.52 out of 10 vs 3.89 in the No-Psych-Dx group (p = 0.035), and POD1 morphine milliequivalents (MMEs) in the Psych-Dx group were 60.2 vs 44.96 in the No-Psych-Dx group (p = 0.015). A portion of patients (25, 10.1%) were diagnosed with a new psychiatric condition postoperatively, and 46 patients (18.5%) were started on a new or different psychiatric medication.

Conclusions: In patients undergoing free flap reconstruction for head and neck cancer, those with psychiatric comorbidities experience subjectively worse pain postoperatively, which leads to an increased requirement of MMEs and a higher frequency of pain management consultation. A notable subset of patients was diagnosed with a new psychiatric condition or started on a new psychiatric medication postoperatively. This study highlights the need for coordinated psychiatric care both pre and postoperatively in patients undergoing free flap reconstruction for head and neck cancer.

    Presenting Author(s)

  • Kelly L. Vittetoe, MD

    Resident MD
    Vanderbilt University
    Nashville, Tennessee, United States

    Disclosure information not submitted.

    • Co-Author(s)

  • Marina Aweeda, BS

    Medical Student
    Vanderbilt University Medical Center
    Nashville, TN, United States

    Disclosure(s):

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

  • LG

    Lily Gao, BA

    Vanderbilt University School of Medicine, Tennessee, United States

    Disclosure information not submitted.

  • Christopher Naranjo, BS

    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.

  • Wenda Ye, MD

    Resident
    Vanderbilt University Medical Center
    Nashville, TN, United States

    Disclosure(s):

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

  • AL

    Alexander Langerman, MD

    Associate Professor
    Vanderbilt University Medical Center
    Nashville, TN, United States

    Disclosure(s):

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

  • MT

    Michael C. Topf, MD, MSCI

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

    Disclosure(s):

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

  • KM

    Kyle Mannion, MD

    Associate Professor
    Vanderbilt University Medical Center
    nashville, TN, United States

    Disclosure information not submitted.

  • James l. Netterville, MD

    Professor of Head and Neck Oncology, Mark C. Smith Chair in Head and Neck Oncologic Services
    Vanderbilt University Medical Center
    Nashville, TN, United States

    Disclosure(s):

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

  • Eben L. Rosenthal, MD

    Professor and Chair
    Vanderbilt University Medical Center
    Nashville, TN, United States

    Disclosure(s):

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

  • RS

    Robert J. Sinard, MD

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

    Disclosure(s):

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

  • Sarah L. Rohde, MD

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

    Disclosure(s):

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

  • AG

    Alexander H. Gelbard, MD

    Associate Professor
    Vanderbilt University Medical Center
    Nashville, TN, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Melanie D. Hicks, MD

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

    Disclosure information not submitted.