Impact of the COVID-19 Pandemic on Outcomes After Head and Neck Free Flap Reconstruction.

OBJECTIVE: To compare perioperative management and clinical outcomes of patients undergoing head and neck free flap reconstruction before and during the COVID-19 pandemic. METHODS: Retrospective cohort study of 220 patients who underwent microvascular free flap reconstruction by a single surgeon at a tertiary academic medical center. Perioperative practices and postoperative outcomes, including length of stay, wound infection, complications, two-year survival, and recurrence, were compared between cohorts. Poisson regression with robust error variance was used to calculate adjusted relative risks (RRs). RESULTS: Demographic and baseline oncologic characteristics were largely similar between cohorts. During the pandemic, patients were less likely to undergo intraoperative tracheostomy and PEG placement. Regression analysis showed the pandemic period was independently associated with increased wound infection risk and reduced recurrence. CONCLUSIONS: Head and neck free flap reconstruction remained safe during the COVID-19 pandemic, with stable cancer outcomes despite shifts in perioperative practice. However, the higher risk of wound infection highlights the need for targeted preventive strategies during times of healthcare disruption.