Mental health risk factors for increased postoperative pain in head and neck cancer free flap reconstruction patients
Otolaryngology–Head and Neck Surgery, 2026
Postoperative pain after head and neck free flap reconstruction (FFR) remains difficult to predict, particularly in patients with a comorbid mental health disorder (MHD), representing a key gap in perioperative care. In this cohort of 645 patients, higher postoperative day (POD) 5 pain scores were independently associated with MHD (β: 0.43; 95% CI: 0.03–0.84), current smoking (β: 0.58; 95% CI: 0.14–1.03), separated/divorced status (β: 0.71; 95% CI: 0.03–1.39), OCRFFF reconstruction (β: 0.54; 95% CI: 0.02–1.05), laryngeal primary site (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 service consultation was also associated with MHD (aOR: 1.99; 95% CI: 1.13–3.52), preoperative narcotic use (aOR: 3.20; 95% CI: 1.77–5.79), and OCRFFF (aOR: 3.42; 95% CI: 1.53–7.66). These findings highlight the significant role of psychosocial and clinical factors in postoperative pain and support preoperative risk stratification to guide personalized pain management strategies.
Recommended citation: Habib DRS, Sridhar S, Larson D, Suh H, Swain BB, Vittetoe K, Sengstack D, Topf MC, Hicks MD. Mental health risk factors for increased postoperative pain in head and neck cancer free flap reconstruction patients. Otolaryngol Head Neck Surg. 2026. doi:10.1002/ohn.70269