Rebecca W. Gao, MD: No relevant relationships to disclose.
Keith A. Casper, MD: No relevant relationships to disclose.
Introduction: Patients who undergo surgery for head and neck cancer may encounter significant postoperative care needs in the setting of complex socioeconomic barriers which lead to increased hospital length of stay and patient and caregiver hardship. Our study thus sought to gain a better understanding of the perioperative surgical experience and pilot a novel preoperative visit targeting socioeconomic and perioperative care concerns.
Methods: To examine perioperative patient experiences, we first performed a mixed methods analysis of 28 adult patients with head and neck cancer undergoing surgical resection with free flap reconstruction at a tertiary care center from October 2022-January 2023. 6 patients underwent semi-structed interviews preoperatively and 22 postoperatively. We used grounded theory thematic analysis of the interviews to develop a unique preoperative virtual visit focused on socioeconomic and perioperative needs. 10 visits were then conducted by advanced practice providers, and visit content was analyzed.
Results: Before the new preoperative visit, 57% of patients did not plan for postoperative care preoperatively, 71% did not feel comfortable with postoperative care needs, and 32% made significant changes to their discharge plans while inpatient. Patients were surprised by the extent of resection (7%), the tracheostomy (18%), or the reconstruction (25%). 50% reported unaddressed socioeconomic hardship. Themes included: interest in visual explanatory aids, caregiver anxiety, and challenges with the inability to speak postoperatively. After the new preoperative visit, 100% of patients reported high satisfaction, and 60% of visits addressed significant care-related concerns that were not previously identified.
Conclusions: Patients reported significant limitations in their understanding of surgery, challenges with postoperative care, and unaddressed socioeconomic hardship. An additional preoperative virtual visit by a midlevel provider may help improve surgical expectations and better prepare patients and their caregivers for perioperative needs.
