Patients undergoing head and neck reconstruction may continue to experience clinically meaningful changes in quality of life beyond the first postoperative year, challenging the assumption that recovery stabilizes by 12 months.
Researchers prospectively followed 315 patients who underwent free flap reconstruction for benign or malignant head and neck disease at a tertiary referral center in Taiwan between 2015 and 2023. Patients completed the University of Wisconsin Quality of Life questionnaire before surgery and at approximately one, two, and three years postoperatively. The investigators evaluated quality-of-life trajectories using a time-to-deterioration approach, which defines deterioration as a clinically meaningful decline that does not subsequently recover and accounts for patient adaptation over time. Median follow-up exceeded three years.
The primary outcome was the physical domain score of the University of Wisconsin Quality of Life questionnaire. The primary endpoint was time to quality-of-life deterioration, while the secondary endpoint was a composite of quality-of-life deterioration or death. Researchers also performed baseline and 12-month landmark analyses to identify factors associated with deterioration and developed exploratory risk prediction models.
The findings suggested that quality of life remained dynamic beyond the first postoperative year. Among 192 patients with assessments at both years one and two, 60% experienced clinically meaningful changes despite stable average cohort scores. Approximately 30% improved, while another 30% deteriorated. Between years two and three, 56% of patients also experienced clinically meaningful changes, indicating that patient-level trajectories continued to evolve even though population mean scores changed little.
Baseline analyses identified a higher Charlson Comorbidity Index as the only independent factor associated with later quality-of-life deterioration. In the prespecified 12-month landmark analysis, higher comorbidity burden, chemotherapy, and complications present at one year were associated with subsequent deterioration. Among these, one-year complications emerged as the strongest potentially modifiable predictor. Similar findings were observed when analyses were limited to patients with malignant disease.
Researchers also developed exploratory baseline and one-year risk scores to stratify patients according to their risk of future quality-of-life deterioration. More than one-third of patients changed risk category between baseline and the one-year assessment, suggesting that postoperative risk continued to evolve over time. Lower body mass index, smoking, and radiotherapy were associated with persistent complications at one year.
The researchers noted that the study’s single-center design may limit generalizability and that residual confounding could not be excluded. Loss to follow-up beyond one year may have influenced long-term estimates, although follow-up rates were comparable with previous longitudinal quality-of-life studies. In addition, the exploratory risk prediction models require validation in multicenter cohorts before clinical implementation.
Overall, the findings suggest that quality of life following head and neck reconstruction may continue to change beyond the first postoperative year, supporting continued reassessment rather than assuming recovery has plateaued.
“QOL after head and neck reconstruction remains dynamic beyond 1 year, with more than half of patients experiencing clinically meaningful changes,” wrote lead study author Steven J. Lo, MA, of the Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom, and colleagues.
Disclosures: The authors reported no conflicts of interest.
