Disparities in Postoperative Outcomes for Low Socioeconomic Status Patients Undergoing Fibula Free Flap Head and Neck Reconstruction
Moreen Njoroge1, Allison Karwoski1, Bashar Hassan1, Alina Galaria2, Matthew Heron1, Cynthia Yusuf1, Christopher Lopez1, Kofi Boahene3, Robin Yang1
1Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, USA; 2Johns Hopkins University, USA; 3Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, USA
The free fibula flap (FFF) has been the most commonly used flap in head and neck bony reconstruction. Postoperative complications have been reported in up to 54% of cases and include infection, flap failure, and donor site morbidity1. Pre-operative radiation treatment, lower median household income, and comorbidities have been determined to be risk factors for these complications. The purpose of this study was to investigate the association between socioeconomic status (SES) and postoperative complications following FFF head and neck reconstruction.
Our study is a retrospective cohort of patients who underwent FFF head and neck reconstruction from 2016 to 2022. Our primary outcome was the incidence of 30-, 90-, and 180-day postoperative complications, including unplanned readmission and reoperation. Bivariate analysis was performed to determine potential associations between patient demographics, comorbidities, and socioeconomic factors (including median household income and insurance type).
Of n=63 patients included in our study, the median (interquartile range [IQR]) age was 59 years and n=34 (54%) were males. Patients who underwent preoperative radiation therapy to the surgical site were more likely to develop 30 and 180-day postoperative complications (n=17 [51.5%], n=7 [23.3%], P=0.021; n=12 [36.4%], n=4 [13.3%], P=0.036, respectively]. The most common postoperative complications were recipient surgical site infection (n=10 [15.9%]) and wound dehiscence (n=9 [14.3%]). Compared to patients with middle-to-high household income, those with a low median household income (MHI less than $55,262) were more likely to experience unplanned readmission [n=7 [46.7%], n=11 [22.9%], P=0.045) and unplanned reoperation (n=8 [53.3%], n=12 [25%], P=0.011).
Disparities in postoperative outcomes exist among low SES patients undergoing FFF head and neck reconstruction. Healthcare initiatives aimed at increasing healthcare access and proper perioperative care are essential to help mitigate the risk of postoperative complications in patients seeking head and neck reconstruction.
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