Publications by authors named "Rosh K Sethi"

64 Publications

Payer-Negotiated Prices in the Diagnosis and Management of Thyroid Cancer in 2021.

JAMA 2021 Jun 4. Epub 2021 Jun 4.

Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts.

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http://dx.doi.org/10.1001/jama.2021.8535DOI Listing
June 2021

Single-surgeon parotidectomy outcomes in an academic center experience during a 15-year period.

Laryngoscope Investig Otolaryngol 2020 Dec 21;5(6):1096-1103. Epub 2020 Oct 21.

Department of Otolaryngology Harvard Medical School Boston Massachusetts USA.

Objective: As large single-surgeon series in the literature are lacking, we sought to review a single-surgeon's experience with parotidectomy in an academic center, with a focused analysis of pathology, technique, and facial nerve (FN) weakness. Benchmark values for complications and operative times with routine trainee involvement and without continuous FN monitoring are offered.

Materials And Methods: All patients who underwent parotidectomy, performed by D. G. D., for benign and malignant disease between January 2004 and December 2018 at an academic center were reviewed.

Results: A total of 924 parotidectomies, with adequate evaluatable data were identified. The majority of patients had benign tumors (70.9%). Partial/superficial parotidectomy was the most common approach (65.7%). Selective FN branch sacrifice was rare (12.3%), but significantly more common among patients with malignant pathology (33.8% vs 3.5% for benign,  < .0001). Among patients with intact FN, post-operative short- and long-term FN weaknesses were rare (6.5% and 1.7%, respectively). These rates were lower among patients with benign tumors (5.4% and 1.3%). Partial/superficial parotidectomy for benign tumors was associated with a low rate of short- and long-term FN weaknesses (2.7% and 0.9%). Mean OR time was 185 minutes.

Conclusion: This is the largest single-surgeon series on parotidectomy, spanning 15 years. We demonstrate excellent long- and short-term FN paresis rates with acceptable operative times without regular use of continuous FN monitoring and with routine trainee involvement. These findings may provide valuable insight into parotid tumor pathology, FN outcomes, and feasibility and expectations of performing parotidectomy in an academic setting.

Level Of Evidence: 4.
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http://dx.doi.org/10.1002/lio2.480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752052PMC
December 2020

Complications of Transoral Robotic Surgery.

Otolaryngol Clin North Am 2020 Dec 8;53(6):1109-1115. Epub 2020 Sep 8.

Department of Otolaryngology-Head and Neck Surgery, University of Michigan, 1904 Taubman Center, 1400 East Medical Center Drive, Ann Arbor, MI 48109, USA. Electronic address:

This article summarizes major and minor complications following transoral robotic surgery in the head and neck. Overall, transoral robotic surgery is extremely safe; however, surgeons must recognize inherent risks associated with major and severe bleeding, dysphagia, and minor complications, including injury to nerves, mucosal surfaces, teeth, and the eyes. This article briefly discusses prevention and management strategies for common complications.
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http://dx.doi.org/10.1016/j.otc.2020.07.017DOI Listing
December 2020

Cost-effectiveness analysis of using the heat and moisture exchangers compared with alternative stoma covers in laryngectomy rehabilitation: US perspective.

Head Neck 2020 12 4;42(12):3720-3734. Epub 2020 Sep 4.

Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.

Background: This study aims to evaluate the cost-effectiveness of using heat and moisture exchangers (HMEs) vs alternative stoma covers (ASCs) following laryngectomy in the United States.

Methods: A cost-effectiveness and budget impact analysis were conducted including uncertainty analyses using real-world survey data with pulmonary events and productivity loss.

Results: HME use was more effective and less costly compared with ASCs. Quality-adjusted life years were slightly higher for HME-users. Total costs per patient (lifetime) were $59 362 (HME) and $102 416 (ASC). Pulmonary events and productivity loss occurred more frequently in the ASC-users. Annual budget savings were up to $40 183 593. Costs per pulmonary event averted were $3770.

Conclusions: HME utilization in laryngectomy patients was cost-effective. Reimbursement of HME devices is thus recommended. Utilities may be underestimated due to the generic utility instrument used and sample size. Therefore, we recommend development of a disease-specific utility tool to incorporate in future analyses.
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http://dx.doi.org/10.1002/hed.26442DOI Listing
December 2020

Margin Practices in Oral Cavity Cancer Resections: Survey of American Head and Neck Society Members.

Laryngoscope 2021 04 22;131(4):782-787. Epub 2020 Aug 22.

Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, U.S.A.

Objectives/hypothesis: To investigate the definition of a clear margin and the use of frozen section (FS) among practicing head and neck surgeons in oral cancer management.

Study Design: Cross-sectional survey.

Methods: We designed a survey that was sent to American Head and Neck Society (AHNS) members via an email link.

Results: A total of 185 (13% of 1,392) AHNS members completed our survey. Most surgeons surveyed (96.8%) use FS to supplement oral cavity squamous cell carcinoma resections. Fifty-five percent prefer a specimen-based approach. The majority of respondents believe FS is efficacious in guiding re-resection of positive margins, with 81% considering the new margin to be negative. More than half of respondents defined a distance of >5 mm on microscopic examination as a negative margin.

Conclusions: To avoid oral cancer resections that result in positive margins on final analysis, and thus the need for additional therapy, most surgeons surveyed use FS. A majority of surveyed surgeons now prefer a specimen-based approach to margin assessment. Although there is a debate on what constitutes a negative margin, most surgeons surveyed believe it to be >5 mm on microscopic examination.

Level Of Evidence: 4 Laryngoscope, 131:782-787, 2021.
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http://dx.doi.org/10.1002/lary.28976DOI Listing
April 2021

State Medicaid expansion status, insurance coverage and stage at diagnosis in head and neck cancer patients.

Oral Oncol 2020 11 3;110:104870. Epub 2020 Jul 3.

Harvard Medical School, Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Boston, MA, USA.

Objectives: Only one in three head and neck cancer (HNC) patients present with early-stage disease. We aimed to quantify associations between state Medicaid expansions and changes in insurance coverage rates and stage at diagnosis of HNC.

Methods: Using a quasi-experimental difference-in-differences (DID) approach and data from 26,330 cases included in the Surveillance, Epidemiology, and End Results program (2011-2015), we retrospectively examined changes in insurance coverage and stage at diagnosis of adult HNC in states that expanded Medicaid (EXP) versus those that did not (NEXP).

Results: There was a significant increase in Medicaid coverage in EXP (+1.6 percentage point (PP) versus) vs. NEXP (-1.8 PP) states (3.36 PP, 95% CI = 1.32, 5.41; p = 0.001), and this increase was mostly among residents of low income and education counties. We also observed a reduction in uninsured rates among HNC patients in low income counties (-4.17 PP, 95% CI = -6.84, -1.51; p = 0.002). Overall, early stage diagnosis rates were 28.3% (EXP) vs. 26.7% (NEXP), with significant increases in early stage diagnosis post-Medicaid expansion among young adults, 18-34 years (17.2 PP, 95% CI - 1.34 to 33.1, p = 0.034), females (7.54 PP, 95% CI = 2.00 to 13.10, p = 0.008), unmarried patients (3.83 PP, 95% CI = 0.30-7.35, p = 0.033), and patients with lip cancer (13.5 PP, 95% CI = 2.67-24.3, p = 0.015).

Conclusions: Medicaid expansion is associated with improved insurance coverage rates for HNC patients, particularly those with low income, and increases in early stage diagnoses for young adults and women.
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http://dx.doi.org/10.1016/j.oraloncology.2020.104870DOI Listing
November 2020

Predicting length of stay in head and neck patients who undergo free flap reconstruction.

Laryngoscope Investig Otolaryngol 2020 Jun 28;5(3):461-467. Epub 2020 May 28.

Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston Massachusetts USA.

Objective: Understanding factors that affect postoperative length of stay (LOS) may improve patient recovery, hasten postoperative discharge, and minimize institutional costs. This study sought to (a) describe LOS among head and neck patients undergoing free flap reconstruction and (b) identify factors that predict increased LOS.

Methods: A retrospective cohort was performed of 282 head and neck patients with free flap reconstruction for oncologic resection between 2011 and 2013 at a tertiary academic medical center. Patient demographics, tumor characteristics, and surgical and infectious complications were characterized. Multivariable regression identified predictors of increased LOS.

Results: A total of 282 patients were included. Mean age was 64.7 years (SD = 12.2) and 40% were female. Most tumors were located in the oral cavity (53.9% of patients), and most patients underwent radial forearm free flap (RFFF) reconstruction (RFFF-73.8%, anterolateral thigh flap-11.3%, and fibula free flap-14.9%). Intraoperative complications were rare. The most common postoperative complications included nonwound infection (pneumonia [PNA] or urinary tract infection [UTI]) (15.6%) and wound breakdown/fistula (15.2%). Mean and median LOS were 13 days (SD = 7.7) and 10 days (interquartile range = 7), respectively. Statistically significant predictors of increased LOS included flap take back (Beta coefficient [] = +4.26,  < .0001), in-hospital PNA or UTI ( = +2.52, = .037), wound breakdown or fistula ( = +5.0,  < .0001), surgical site infection ( = +3.54, = .017), and prior radiation therapy ( = +2.59, = .004).

Conclusion: Several perioperative factors are associated with increased LOS. These findings may help with perioperative planning, including the need for vigilant wound care, optimization of antibiotics prophylaxis, and institution-level protocols for postoperative care and disposition of free flap patients.

Level Of Evidence: 2b; retrospective cohort.
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http://dx.doi.org/10.1002/lio2.410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314462PMC
June 2020

Change in stage of presentation of head and neck cancer in the United States before and after the affordable care act.

Cancer Epidemiol 2020 08 24;67:101763. Epub 2020 Jun 24.

Saint Louis University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Saint Louis, MO, USA; Saint Louis University Cancer Center, Saint Louis, MO, USA. Electronic address:

Objective/hypothesis: Early diagnosis and stage at presentation, two prognostic factors for survival among patients with head and neck cancer (HNC), are significantly impacted by a patient's health insurance status. We aimed to assess the impact of the Patient Protection and Affordable Care Act (ACA) on stage at presentation across socioeconomic and demographic subpopulations of HNC patients in the United States.

Study Design: Retrospective data analysis.

Methods: The National Cancer Database, a hospital-based cancer database (2011-2015), was queried for adults aged 18-64 years and diagnosed with a malignant primary HNC. The outcome of interest was change in early-stage diagnoses between 2011-2013 (pre-ACA) and 2014-2015 (post-ACA) using logistic regression models.

Results: A total of 91,137 HNC cases were identified in the pre-ACA (n = 53,726) and post-ACA (n = 37,411) years. Overall, the odds of early-stage diagnoses did not change significantly post-ACA (aOR = 0.97, 95 % CI 0.94, 1.00; p = 0.081). However, based on health insurance status, HNC patients with Medicaid were significantly more likely to present with early-stage disease post-ACA (aOR = 1.12, 95 % CI 1.03, 1.21; p = 0.007). We did not observe increased odds of early-stage presentation for other insurance types. Males were less likely to present with early-stage disease, pre- or post-ACA.

Conclusions: We demonstrate a significant association between ACA implementation and increased early-stage presentation among Medicaid-enrolled HNC patients. This suggests that coverage expansions through the ACA may be associated with increased access to care and may yield greater benefits among low-income HNC patients.
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http://dx.doi.org/10.1016/j.canep.2020.101763DOI Listing
August 2020

National Trends in Surgical Resection of Vestibular Schwannomas.

Otolaryngol Head Neck Surg 2020 12 23;163(6):1244-1249. Epub 2020 Jun 23.

Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.

Objective: To characterize the national trend for surgical resection of vestibular schwannoma (VS) and to assess changes in demographics, length of stay (LOS), discharge patterns, and hospital charges.

Study Design: Population-based inpatient registry analysis.

Setting: National Inpatient Sample and SEER database (Surveillance, Epidemiology, and End Results).

Patients And Methods: Retrospective review of the US National Inpatient Sample and the SEER database from 2001 to 2014 of all patients who underwent resection of VS.

Results: A total of 24,380 VS resections were performed. While the annual incidence of VS remained stable at 1.38 per 100,000, surgical volume declined by 36.1%, from 2807 in 2001 to 1795 in 2014 ( = 0.58). Total hospital charges more than doubled, from $52,475 in 2001 to $115,164 in 2014 ($4478 per year, = 0.96). While most procedures were performed at large-sized hospitals, this decreased from 89% in 2002 to 75.8% in 2014. Average LOS remained stable at 5.2 days during the study period. The number of discharges to a nursing facility increased from 113 (5.5%) in 2002 to 245 (13.6%) in 2014 ( = .0002).

Conclusion: VS resection has evolved in the United States. While the incidence remained stable, surgical volume decreased by 36%, and hospital charges more than doubled. More cases are being performed at smaller hospitals. Although LOS did not vary significantly, there is an increase in nonroutine discharges. These data may guide future research in resource utilization in neurotology.
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http://dx.doi.org/10.1177/0194599820932148DOI Listing
December 2020

Impact of the Patient Protection and Affordable Care Act on cost-related medication underuse in nonelderly adult cancer survivors.

Cancer 2020 06 18;126(12):2892-2899. Epub 2020 Mar 18.

Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.

Background: Cost-related medication underuse (CRMU), a measure of access to care and financial burden, is prevalent among cancer survivors. The authors quantified the impact of the Patient Protection and Affordable Care Act (ACA) on CRMU in nonelderly cancer survivors.

Methods: Using National Health Interview Survey data (2011-2017) for cancer survivors aged 18 to 74 years, the authors estimated changes in CRMU (defined as taking medication less than prescribed due to costs) before (2011-2013) to after (2015-2017) implementation of the ACA. Difference-in-differences (DID) analyses estimated changes in CRMU after implementation of the ACA in low-income versus high-income cancer survivors, and nonelderly versus elderly cancer survivors.

Results: A total of 6176 cancer survivors aged 18 to 64 years and 4100 cancer survivors aged 65 to 74 years were identified. In DID analyses, there was an 8.33-percentage point (PP) (95% confidence interval, 3.06-13.6 PP; P = .002) decrease in CRMU for cancer survivors aged 18 to 64 years with income <250% of the federal poverty level (FPL) compared with those with income >400% of the FPL. There was a reduction for cancer survivors aged 55 to 64 years compared with those aged 65 to 74 years with income <400% of the FPL (-9.35 PP; 95% confidence interval, -15.6 to -3.14 PP [P = .003]).

Conclusions: There was an ACA-associated reduction in CRMU noted among low-income, nonelderly cancer survivors. The ACA may improve health care access and affordability in this vulnerable population.
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http://dx.doi.org/10.1002/cncr.32836DOI Listing
June 2020

Tracheostomy Complications in the Emergency Department: A National Analysis of 38,271 Cases.

ORL J Otorhinolaryngol Relat Spec 2020;82(2):106-114. Epub 2020 Feb 7.

Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, USA.

Background: Greater than 100,000 tracheotomies are performed annually in the USA, yet little is known regarding patients who present to the emergency department (ED) with tracheostomy complications.

Objectives: To characterize patient and hospital characteristics, outcomes, and charges associated with tracheostomy complications and to identify predictors of admission and mortality.

Methods: The 2009-2011 Nationwide Emergency Department Sample (NEDS) was queried for patients with a principle diagnosis of tracheostomy complication. A descriptive analysis was performed and multivariable logistic regression was used to identify predictors of admission and mortality.

Results: A total of 69,371 nationwide visits to the ED had tracheostomy complication as an associated ICD-9 diagnosis, of which 55.2% (n = 38,293) carried a primary diagnosis of tracheostomy complication. Unspecified tracheostomy complications were most common (61.4%), followed by mechanical complications (31.3%), and lastly by tracheostomy infections (7.3%). Pediatric patients were significantly more likely to have tracheostomy infections than adults (p < 0.0001). A total of 35.5% of patients with tracheostomy complications were admitted to the hospital, and death occurred with 1.4% of visits. Patients from higher-income ZIP codes had increased odds of admission (adjusted odds ratio [OR]: 1.35; p = 0.0009), as did patients with tracheostomy infections (OR: 4.425; p < 0.0001). Patients with tracheostomy infections (OR: 3.14; p = 0.0062) and unspecified tracheostomy complications (OR: 2.00; p = 0.0076) had increased odds of mortality.

Conclusion: These findings may help improve overall outcomes amongst patients with tracheostomies by preventing unnecessary ED admissions and improving healthcare provider preparedness and awareness.
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http://dx.doi.org/10.1159/000505130DOI Listing
February 2021

Radial Forearm Free Flap for Cochlear Implant Coverage in a Post-Irradiated Field.

Otol Neurotol 2020 Feb;41(2):192-195

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear/Massachusetts General Hospital.

Objective: To describe a novel use of a radial forearm free flap (RFFF) for soft tissue coverage over a cochlear implant (CI) in a post-irradiated field.

Patients: Single patient case report of a woman with a history of radiation therapy for brainstem astrocytoma who suffered from repeated CI extrusion despite tympanomastoid obliteration and locoregional pedicled flap soft tissue coverage.

Intervention(s): Sequential bilateral, single-staged revision cochlear implantation with RFFF soft tissue coverage.

Main Outcome Measure(s): Postoperative wound healing complications including infection or device extrusion.

Results: There have been no further issues with wound healing, infection, or device extrusion with a follow up period of 3 years on one side and 8 months on the second side. Both CIs are functioning well with the flaps being sufficiently thin to allow for the use of typical external processor magnets.

Conclusions: A RFFF can be used to provide robust soft tissue coverage over a CI in a post-irradiated field. The RFFF and CI may safely be performed in a single operation.
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http://dx.doi.org/10.1097/MAO.0000000000002468DOI Listing
February 2020

Predictive factors for prolonged operative time in head and neck patients undergoing free flap reconstruction.

Am J Otolaryngol 2020 Mar - Apr;41(2):102392. Epub 2020 Jan 3.

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA. Electronic address:

Purpose: Defining the predictive factors associated with prolonged operative time may reduce post-operative complications, improve patient outcomes, and decrease cost of care. The aims of this study are to 1) analyze risk factors associated with prolonged operative time in head and neck free flap patients and 2) determine the impact of lengthier operative time on surgical outcomes.

Methods: This retrospective cohort study evaluated 282 head and neck free flap reconstruction patients between 2011 and 2013 at a tertiary care center. Perioperative factors investigated by multivariate analyses included gender, age, American Society of Anesthesiologists class, tumor subsite, stage, flap type, preoperative comorbidities, and perioperative hematocrit nadir. Association was explored between operative times and complications including flap take back, flap survival, transfusion requirement, flap site hematoma, and surgical site infection.

Results: Mean operative time was 418.2 ± 88.4 (185-670) minutes. Multivariate analyses identified that ASA class III (beta coefficient + 24.5, p = .043), stage IV tumors (+34.8, p = .013), fibular free flaps (-44.8, p = .033 for RFFF vs. FFF and - 67.7, p = .023 for ALT vs FFF) and COPD (+36.0, p = .041) were associated with prolonged operative time. History of CAD (-43.5, p = .010) was associated with shorter operative time. There was no statistically significant association between longer operative time and adverse flap outcomes or complications.

Conclusion: As expected, patients who were medically complex, had advanced cancer, or underwent complex flap reconstruction had longer operative times. Surgical planning should pay special attention to certain co-morbidities such as COPD, and explore innovative ways to minimize operative time. Future research is needed to evaluate how these factors can help guide planning algorithms for head and neck patients.
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http://dx.doi.org/10.1016/j.amjoto.2020.102392DOI Listing
August 2020

Outcomes and prognostic factors in parotid gland malignancies: A 10-year single center experience.

Laryngoscope Investig Otolaryngol 2019 Dec 13;4(6):632-639. Epub 2019 Nov 13.

Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston Massachusetts.

Objectives: To describe a 10-year single center experience with parotid gland malignancies and to determine factors affecting outcomes.

Study Design: Retrospective review.

Methods: The institutional cancer registry was used to identify patients treated surgically for malignancies of the parotid gland between January 2005 and December 2014. Clinical and pathologic data were collected retrospectively from patient charts and analyzed for their association with overall survival (OS) and disease-free survival (DFS).

Results: Two hundred patients were identified. Mean age at surgery was 57.8 years, and mean follow-up time was 52 months. One hundred two patients underwent total parotidectomy, while 77 underwent superficial parotidectomy, and 21 underwent deep lobe resection. Seventy patients (35%) required facial nerve (FN) sacrifice. Acinic cell carcinoma was the most common histologic type (22%), followed by mucoepidermoid carcinoma (21.5%) and adenoid cystic carcinoma (12.5%). Twenty-nine patients (14.5%) experienced recurrences, with mean time to recurrence of 23.6 months (range: 1-82 months). Five- and 10-year OS were 81% and 73%, respectively. Five- and 10-year DFS were 80% and 73%, respectively. In univariate analyses, age > 60, histologic type, positive margins, high grade, T-stage, node positivity, perineural invasion, and FN involvement were predictors of OS and DFS. In the multivariate analysis, histology, positive margins, node positivity, and FN involvement were independent predictors of OS and DFS.

Conclusions: Our single-center experience of 200 patients suggests that histology, positive margins, node positivity, and FN involvement are independently associated with outcomes in parotid malignancies.

Level Of Evidence: 4.
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http://dx.doi.org/10.1002/lio2.326DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929571PMC
December 2019

Socioeconomic and Demographic Variation in Insurance Coverage Among Patients With Head and Neck Cancer After the Affordable Care Act.

JAMA Otolaryngol Head Neck Surg 2019 12;145(12):1144-1149

St Louis University School of Medicine, St Louis, Missouri.

Importance: Health insurance status has a significant association with early diagnosis and stage at presentation, which are the most important predictors of survival among patients with head and neck cancer (HNC). Literature on the association of the Patient Protection and Affordable Care Act (ACA) with changes in insurance status among patients with HNC remains limited. To our knowledge, no studies have evaluated changes in insurance rates across sociodemographic subgroups of patients with HNC.

Objective: To assess the association of the implementation of the ACA with insurance status across socioeconomic and demographic subpopulations of patients with HNC.

Design, Setting, And Participants: A retrospective cohort study using data from the National Cancer Database (NCDB), a hospital-based cancer registry (2011-2015) for adults diagnosed with a malignant primary HNC was carried out. The analyses were conducted from November 2018 through December 2018.

Main Outcomes And Measures: Changes in the percentage of patients with insurance.

Results: A total of 131 779 patients with HNC were identified in the pre-ACA (77 071) and post-ACA (54 708) periods. Overall, 98 207 (74.5%) participants were men and 33 572 (25.5) were women, with 73 124 (55.5%) being aged between 50 to 64 years. There was a 2.68 percentage point decrease (PPD) (95% CI, 2.93-2.42) in the percentage of patients with HNC without insurance from the pre-ACA to the post-ACA period. Changes in the percentage of uninsured patients varied significantly by age, with the largest reduction in uninsured status among patients with HNC aged 18 to 34 years (5.12 PPD; 95% CI, 3.18-7.06) and the smallest reduction in uninsured among those aged 65 to 74 years (0.24 PPD; 95% CI, 0.03-0.45). There was a significantly greater reduction in uninsured status in low-income zip codes (3.45 PPD; 95% CI, 2.76-4.14) than in high-income zip codes (1.99 PPD; 95% CI, 1.63-2.36).

Conclusions And Relevance: There was a significant association between ACA implementation and percentage decrease in uninsured patients. Young adults and those residing in low-income zip codes experienced a significantly higher rate of insurance uptake compared with older adults and residents of high-income areas. This suggests that coverage expansions enacted through the ACA are not only associated with increased access to care among the broader HNC population, but that they may also yield a greater benefit among subpopulations with historically limited insurance coverage.
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http://dx.doi.org/10.1001/jamaoto.2019.2724DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824226PMC
December 2019

Elective neck dissection for salvage laryngectomy: A systematic review and meta-analysis.

Oral Oncol 2019 09 17;96:97-104. Epub 2019 Jul 17.

Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA. Electronic address:

Objective: Elective neck dissection (END) for salvage laryngectomy remains controversial due to variability in reported occult nodal metastasis rates and postoperative complications. We performed a meta-analysis to examine the role of END for treatment of the clinically N0 (cN0) neck in the salvage setting.

Methods: A PubMed search, without limit on years searched, was conducted for English language articles. Additional sources were found by reviewing bibliographies of pertinent articles. Studies had to include END data for salvage laryngectomy for locally recurrent squamous cell carcinoma of the larynx with clinically negative regional metastasis. For patients who underwent END, pathological node status had to be reported. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations were followed. Data were pooled using a random-effects model.

Results: Nineteen studies were included in the analysis. Within the END group, 31% were supraglottic, 61% were glottic, 6% were transglottic, and 1% were subglottic. The pooled rate of occult nodal metastasis was 14% (95% CI = 0.11-0.17) for all subsites. In subsite-specific analyses, occult nodal metastasis rates were 24% for supraglottic, 9% for glottic, and 17% for transglottic recurrences. Occult nodal metastasis was higher in recurrent T3/4 tumors (21%) compared to recurrent T1/2 tumors (9%) (relative risk (RR) = 2.17, 95% CI = 1.23-3.63, p = 0.003). The RR of postoperative complications with END compared to observation was 1.72 (95% CI = 0.96-3.10, p = 0.07).

Conclusions: The highest rates of occult nodal metastasis are associated with supraglottic recurrence and recurrent T3/T4 tumors. These data should be considered when deciding whether to perform END for salvage laryngectomy.
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http://dx.doi.org/10.1016/j.oraloncology.2019.07.008DOI Listing
September 2019

ACUTE OTITIS MEDIA AND ASSOCIATED COMPLICATIONS IN UNITED STATES EMERGENCY DEPARTMENTS.

Otol Neurotol 2019 07;40(6):847

Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.

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http://dx.doi.org/10.1097/MAO.0000000000002280DOI Listing
July 2019

Patient-reported auditory handicap measures following mild traumatic brain injury.

Laryngoscope 2020 03 8;130(3):761-767. Epub 2019 May 8.

Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts.

Objectives/hypothesis: Few studies have specifically addressed auditory complaints in patients with nonblast mild traumatic brain injury (mTBI). Herein, we aimed to investigate auditory symptoms in patients following mTBI using patient-reported outcome measures.

Study Design: Retrospective analysis of prospectively collected data in a tertiary-care hospital.

Methods: The patients included those with mTBI (cases) and those without mTBI (controls). Individuals (≥18 years old) with and without mTBI were screened. Exclusion criteria included history of otologic disorders, blast injury, or occupational noise exposure. Primary outcomes included the Hearing Handicap Inventory for Adults (HHIA), Tinnitus Handicap Inventory (THI), and Hyperacusis Questionnaire (HQ). Secondary outcomes included subjective auditory complaints.

Results: From September 2017 to September 2018, 52 patients with mTBI and 55 controls met inclusion and exclusion criteria. The mean time between mTBI and survey intake was 70.6 months. The mean age and gender were 51.5 years old and 73% female in the mTBI group, and 46.1 years old and 56.3% female in the control group (P = .112 and P = .105, respectively). Patients with mTBI reported hyperacusis (67.3% of all mTBI patients), hearing loss (61.5%), and tinnitus (61.5%), compared to 8.3%, 12.7%, and 16.4%, respectively, for control subjects (P < .0001). The mean HHIA score in the mTBI group was 38.3 versus 8.5 in controls (P = .002). The mean THI score was 27.4 in the mTBI group and 3.1 in controls (P < .0001). The mean HQ score was 26.5 in mTBI group and 7.3 in controls (P = .001).

Conclusions: Auditory symptoms and associated handicap were common in patients with nonblast mTBI compared to age-matched controls. Findings have implications for the pathophysiology and management of symptoms in this patient population.

Level Of Evidence: 3 Laryngoscope, 130:761-767, 2020.
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http://dx.doi.org/10.1002/lary.28034DOI Listing
March 2020

Does Clearance of Positive Margins Improve Local Control in Oral Cavity Cancer? A Meta-analysis.

Otolaryngol Head Neck Surg 2019 08 26;161(2):235-244. Epub 2019 Mar 26.

1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.

Objectives: To compare local recurrence-free survival (LRFS) in early oral cavity cancer (OCC) patients with positive/close frozen section (FS) cleared with further resection (R1 to R0) or positive FS not cleared (R1) to those with negative margins on initial FS analysis (R0).

Data Sources: PubMed, EMBASE, and Cochrane.

Review Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) for reporting in our study. Only English-language articles that included patients with OCC and local recurrence (LR) comparisons between R0 and initially R1 to final R0 or final R1 groups were included. We requested the raw data from the corresponding authors of eligible studies and performed an individual participant data (IPD) meta-analysis of LRFS outcomes across groups.

Results: Pooled LRFS data from 8 studies showed that patients in the R1 to R0 group had worse LRFS compared to the R0 group (hazard ratio [HR] = 2.897, < .001). Patients in the R1 group were also found to have worse LRFS compared to the R0 group (HR = 3.795, < .001). When compared to final R1 group, the initially R1 to final R0 only showed a trend toward better LRFS.

Conclusion: Margin revision of initially positive margins to "clear" based on FS guidance does not equate to an initially negative margin and does not significantly improve local control. These findings call into question the effectiveness of the current methodology of intraoperative FS in OCC resections and call for a prospective study to determine what system of resected specimen analysis best predicts completeness of resection.
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http://dx.doi.org/10.1177/0194599819839006DOI Listing
August 2019

Insurance status, stage of presentation, and survival among female patients with head and neck cancer.

Laryngoscope 2020 02 22;130(2):385-391. Epub 2019 Mar 22.

Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A.

Objectives: Incidence trends and outcomes of head and neck cancer (HNC) among female patients are not well understood. The objective of this study was to estimate incidence trends and quantify the association between health insurance status, stage at presentation, and survival among females with HNC.

Study Design: Retrospective cohort study.

Methods: The Surveillance, Epidemiology, and End Results database (2007-2014) was queried for females aged ≥18 years diagnosed with a malignant primary head and neck cancer (HNC) (n = 18,923). Incidence trends for stage at presentation were estimated using Joinpoint regression analysis. The association between health insurance status and stage at presentation on overall and disease-specific survival was estimated using Fine and Gray proportional hazards models.

Results: Incidence of stage IV HNC rose by 1.24% from 2007 to 2014 (annual percent change = 1.24, 95% CI 0.30, 2.20). Patients with Medicaid (adjusted odds ratio [aOR] = 1.59, 95% confidence interval [CI] 1.45, 1.74) and who were uninsured (aOR = 1.73, 95% CI 1.47, 2.04) were more likely to be diagnosed with advanced stage (stages III/IV) HNC. Similarly, patients with Medicaid (adjusted hazard ratio [aHR] = 1.47, 95% CI 1.38, 1.56) and who were uninsured (aHR =1.45, 95% CI 1.29, 1.63) were more likely to die from any cause compared to privately insured patients. Medicaid (aHR = 1.34, 95% CI 1.24, 1.44) and uninsured (aHR = 1.41, 95% CI 1.24, 1.60) patients also had a greater hazard of HNC-specific deaths compared to privately insured patients.

Conclusions: Incidence of advanced-stage presentation for female HNC patients in the United States has increased significantly since 2007, and patients who are uninsured or enrolled in Medicaid are more likely to present with late stage disease and die earlier.

Level Of Evidence: NA Laryngoscope, 130:385-391, 2020.
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http://dx.doi.org/10.1002/lary.27929DOI Listing
February 2020

Sentinel lymph node biopsy for high-risk cutaneous squamous cell carcinoma of the head and neck.

Laryngoscope 2020 01 7;130(1):108-114. Epub 2019 Mar 7.

Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.

Objectives/hypothesis: To describe outcomes of a single institution experience with sentinel lymph node biopsy (SLNB) for high-risk cutaneous squamous cell carcinoma of the head and neck.

Study Design: Retrospective case series.

Methods: Chart review was performed for patients who presented with clinically node negative cutaneous squamous cell carcinoma of the head and neck between December 2007 and May 2018. Patients who met high-risk criteria underwent SLNB and excision, with or without adjuvant therapy. Patients who underwent prior neck dissection were excluded. The main outcomes were SLNB result, lymph node spread, recurrence-free survival, disease-specific survival, and overall survival.

Results: Eighty-three patients underwent successful SLNB, and one patient underwent selective neck dissection for intraoperatively identified occult lymph node metastasis. Five patients (6%) had a sentinel node positive for tumor, of whom 4/5 received further treatment (neck dissection, radiation, and/or systemic therapy) with no further recurrence at the time of last follow-up. SLNB had a negative predictive value of 95% to 100%. Recurrent tumor at presentation, tumor arising from an area of chronic inflammation, and immunosuppression were significantly associated with increased risk of subsequent recurrence, with a mean follow-up of 19.9 months.

Conclusions: SLNB can be used to identify regional lymph node metastases in cutaneous squamous cell carcinoma of the head and neck with a high negative predictive value (95%-100%). Factors associated with recurrence were tumor being locally recurrent at presentation, arising from an area of chronic inflammation, and immunosuppression.

Level Of Evidence: 4 Laryngoscope, 130:108-114, 2020.
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http://dx.doi.org/10.1002/lary.27881DOI Listing
January 2020

Postoperative care in an intermediate-level medical unit after head and neck microvascular free flap reconstruction.

Laryngoscope Investig Otolaryngol 2019 Feb 28;4(1):39-42. Epub 2018 Nov 28.

Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston Massachusetts.

Objective: The need for intensive care unit (ICU) admission and mechanical ventilation after head and neck microvascular free flap reconstructive surgery remains controversial. Our institution has maintained a longstanding practice of immediately taking patients off mechanical ventilation with subsequent transfer to intermediate, non-ICU level of care with specialized otolaryngologic nursing. Our objective was to describe postoperative outcomes for a large cohort of patients undergoing this protocol and to examine the need for routine ICU transfer.

Materials And Methods: We performed a retrospective review of 512 consecutive free flaps treated with a standard protocol of immediate postoperative transfer to an intermediate-level care unit with specialized otolaryngology nursing. Outcome measures included ICU transfer, ventilator requirement, flap failure, postoperative complications, and length of stay. Predictors of ICU transfer were identified by multivariable logistic regression.

Results: The vast majority of patients did not require intensive care. Only a small fraction (n = 18 patients, 3.5%) subsequently transferred to the ICU, most commonly for respiratory distress, cardiac events, and infection. The most common complications were delirium/agitation (n = 55; 10.7%) and pneumonia (n = 51; 10.0%). Sixty-five cases (12.7%) returned to the OR, most commonly for hematoma/bleeding (n = 41; 8.0%) and anastomosis revision (n = 20; 3.9%). Heavy alcohol consumption and greater number of medical comorbidities were significant predictors of subsequent ICU transfer.

Conclusions: Among head and neck free flap patients, routine cessation of mechanical ventilation and transfer to intermediate-level care with specialized ENT nursing was found to be safe with infrequent subsequent ICU transfer and low complication rates. Routine transfer to intermediate-level care in this population may prevent unnecessary ICU utilization and facilitate the delivery of high-value, disease-centered care.

Level Of Evidence: 3b.
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http://dx.doi.org/10.1002/lio2.221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383293PMC
February 2019

Opioid Prescription Patterns After Rhinoplasty-Reply.

JAMA Facial Plast Surg 2019 05;21(3):264

Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.

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http://dx.doi.org/10.1001/jamafacial.2018.1747DOI Listing
May 2019

Morbidity and mortality among patients with head and neck cancer in the emergency department: A national perspective.

Head Neck 2019 04 24;41(4):1007-1015. Epub 2019 Jan 24.

Center for Global Surgery Evaluation, Massachusetts Eye and Ear, Boston, Massachusetts.

Background: Emergency departments are playing an increasing role in cancer management. Emergency department utilization by patients with head and neck cancer, however, is unknown.

Methods: The 2009-2011 Nationwide Emergency Department Sample was queried for patients with a principle diagnosis of head and neck cancer. Descriptive analysis was performed to characterize patient and hospital characteristics, outcomes, and charges. Logistic regression identified predictors of admission and mortality.

Results: A total of 31 390 patients were seen in the emergency department with head and neck cancer: 72.8% were admitted, 0.5% died in the emergency department, and 5.0% died during admission. Patients with cancer of unknown primary site had the greatest odds of admission (odds ration [OR]: 2.83; P < 0.0001). Privately insured patients (OR: 1.78; P = 0.001), those from higher income zip codes (OR: 1.56; P = 0.008), and those with oropharyngeal cancer (OR: 2.02; P = 0.0003) had the greatest odds of death.

Conclusion: These findings have direct implications for preventing unnecessary and costly emergency department visits, improving hospital and physician preparedness, and improving patient outcomes.
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http://dx.doi.org/10.1002/hed.25534DOI Listing
April 2019

The role of elective neck dissection in patients with adenoid cystic carcinoma of the head and neck.

Laryngoscope 2019 09 22;129(9):2094-2104. Epub 2019 Jan 22.

Department of Otolaryngology, Harvard Medical School; Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.

Objective: To investigate the frequency and outcomes of elective neck dissection (END) for adenoid cystic carcinoma (ACC) of the head and neck.

Methods: The National Cancer Database was queried for a cohort study of patients with ACC of the major salivary glands, nasal cavity/nasopharynx, hard/soft palate, tongue, floor of mouth, larynx, and oral cavity who underwent primary surgical resection from 2004 to 2014. Multivariable logistic regression was used to identify predictors of END and occult nodal metastasis. Overall survival (OS) was estimated using the Kaplan-Meier method and modeled with Cox proportional hazards regression.

Results: Among 2,807 patients with ACC treated surgically, 636 (22.7%) underwent END. Patients with ACC of the salivary glands and tongue most frequently underwent END; patients with hard/soft palate (odds ratio [OR] 0.06, P < 0.001) and nasal cavity/nasopharynx (OR 0.05, P < 0.001) ACC rarely underwent END compared to patients with major salivary gland cancer. Increasing tumor (T) stage (T4 vs. T1, OR 3.02, P < 0.001) was associated with END. Patients with advanced T3 to T4 ACC of the major salivary glands demonstrated extended OS associated with END (5-year OS 78.1% vs. 70.4%, P = 0.041) on Kaplan-Meier analysis and with END with adjuvant radiation therapy (hazard ratio 0.55, P = 0.027) using Cox proportional hazards regression. Elective neck dissection for T4 ACC of the salivary glands (21.3%) and tongue (25.5%) most consistently revealed occult nodal metastasis.

Conclusion: Elective neck dissection for ACC of the major salivary glands or tongue is most likely to reveal occult nodal metastasis. Elective neck dissection is associated with extended OS for advanced-stage ACC of the major salivary glands.

Level Of Evidence: NA Laryngoscope, 129:2094-2104, 2019.
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http://dx.doi.org/10.1002/lary.27814DOI Listing
September 2019

Laryngeal fracture presentation and management in United States emergency rooms.

Laryngoscope 2019 10 8;129(10):2341-2346. Epub 2019 Jan 8.

Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.

Objectives/hypothesis: There are limited data on laryngeal fracture presentation and management in US emergency departments (EDs). We aimed to characterize patients who are diagnosed with laryngeal fractures in the ED and identify management patterns.

Study Design: Retrospective review of the Nationwide Emergency Department Sample (NEDS) from 2009 to 2011.

Methods: The NEDS was queried for patient visits with a primary diagnosis of open or closed laryngeal fracture (International Classification of Diseases, Ninth Revision codes 807.5 and 807.6). Patient demographics, comorbidities, ED management, and hospital characteristics were extracted.

Results: There were 3,102 ED visits with a diagnosis of laryngeal fracture during the study period. Mean patient age was 40.9 years (range, 3-93 years). The majority of patients were male (85.5%) and sustained a closed (vs. open) fracture (91.4%), with an overall mortality rate of 3.8%. The majority of patients were treated for more than one injury during the same visit (76.2%). Most patients were evaluated at a trauma hospital (53.9%), and most patients were admitted to the hospital (71.9%). Emergent intubation or tracheostomy was rarely reported (2.6% and 0.1% of all cases), and a minority of patients underwent fiberoptic flexible laryngoscopy in the ED (1.9%). Laryngeal fractures occurred more frequently during summer months (28.2%). Mean charge for the entirety of the ED stay was $4,957.34.

Conclusions: Laryngeal fracture is rare and frequently associated with other injuries. The frequency of emergent airway procedure, imaging, and flexible fiberoptic laryngoscopy is lower than expected, raising concerns about appropriate workup and management or recognition of injury in the ED setting.

Level Of Evidence: NA Laryngoscope, 129:2341-2346, 2019.
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http://dx.doi.org/10.1002/lary.27790DOI Listing
October 2019

Opioid prescription patterns and use among patients undergoing endoscopic sinus surgery.

Laryngoscope 2019 05 24;129(5):1046-1052. Epub 2018 Dec 24.

Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.

Objectives/hypothesis: Opioid-related deaths in the United States have increased 200% since 2000, in part due to prescription diversion from patients who had a surgical procedure. The purpose of this study was to characterize provider prescription patterns and assess patient-reported opioid use after endoscopic sinus surgery (ESS).

Study Design: Retrospective chart review.

Methods: Patients who underwent ESS between May 2017 and May 2018 were included. Opioid prescription, operative details, and postoperative opioid use data were extracted. The Massachusetts Prescription Awareness Tool (MassPAT) was queried to determine if patients filled their prescription.

Results: One hundred fifty-five patients were included. Nearly all patients received an opioid prescription (94.8%). An average of 15.6 tablets was prescribed per patient. Among 116 patients with MassPAT data, 91.4% filled their prescription. Among 67 patients who reported the number of tablets they had used at the time of first follow-up appointment, 73.1% reported taking no opioids. Mean number of tablets prescribed was significantly greater among patients who underwent primary versus revision surgery (16.5 vs. 13.5, P = .0111) and those who had splints placed (21.5 vs. 15.1, P = .0037). Predictors of opioid use included concurrent turbinate reduction (58.3% vs. 14.3%, P < .0001) and concurrent septoplasty (45.5% vs. 21.6%, P = .039).

Conclusions: Nearly all patients who underwent ESS were prescribed an opioid, and nearly all patients filled their prescription. However, the vast majority of patients did not require any opioid medication for postoperative pain control. As the opioid epidemic continues to persist, these findings have immediate relevance to current prescribing patterns and pain management practices.

Level Of Evidence: 4 Laryngoscope, 129:1046-1052, 2019.
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http://dx.doi.org/10.1002/lary.27672DOI Listing
May 2019

Impact of Age on Sinus Surgery Outcomes.

Laryngoscope 2018 12 3;128(12):2681-2687. Epub 2018 Oct 3.

Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.

Objectives/hypothesis: To evaluate the impact of age on patient-reported quality of life (QOL) following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS).

Study Design: Prospective cohort study.

Methods: Six hundred thirty-six patients with CRS were recruited from 11 otolaryngologic practices and completed the sinonasal-specific, 22-item Sino-Nasal Outcome Test-22 (SNOT-22) and general health-related EuroQol 5-Dimension (EQ-5D) questionnaires at baseline and 12 and 24 months after ESS. Patients were grouped chronologically to determine whether age at time of ESS was associated with clinical outcomes.

Results: Ages ranged from 18 to 80 years (mean ± standard deviation = 48.5 ± 14.4). Improvement was observed in postoperative SNOT-22 scores at 12 and 24 months for all decades of life. Similar improvements were observed for EQ-5D-based health utility value (HUV) scores in all decades of life, except for the eldest cohort (ages 70-80, N = 33), who did not exceed the minimal clinically important difference at either 12 or 24 months following ESS. In regression analysis, age was not associated with sinonasal-specific outcomes (change in SNOT-22 scores) at 12 (P = .507) or 24 months (P = .955). In general health-related outcomes, however, age was significantly associated with change in EQ-5D-based HUV scores from baseline to 12 months following ESS after adjusting for patient demographics, comorbidities, and surgical history (P = .049).

Conclusions: This study demonstrates that ESS for adult CRS sufferers offers improved QOL outcomes through the eighth decade of life. The impact of comorbidities on QOL needs to be carefully considered when assessing older patients for sinus surgery.

Level Of Evidence: 2b Laryngoscope, 128:2681-2687, 2018.
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http://dx.doi.org/10.1002/lary.27285DOI Listing
December 2018

Transfusion in Head and Neck Cancer Patients Undergoing Pedicled Flap Reconstruction.

Laryngoscope 2018 12 24;128(12):E409-E415. Epub 2018 Sep 24.

Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.

Objective: Blood product utilization is monitored to prevent unnecessary transfusions. Head-and-neck pedicled flap reconstruction transfusion-related outcomes were assessed.

Methods: One hundred and thirty-six pedicled flap patients were reviewed: 64 supraclavicular artery island flaps (SCAIF), 57 pectoralis major (PM) flaps, and 15 submental (SM) flaps. Outcome parameters included flap-related complications, medical complications, length of stay (LOS), and flap survival. Multivariable logistic regression analyses were performed. Multivariable logistic regression analyses were performed to adjust for relevant pre- and perioperative factors.

Results: Of all head-and-neck pedicled flap patients included in our analyses (n = 136), 40 (29.4%) received blood transfusions. The average pretransfusion hematocrit (Hct) was 24.3% ± 0.5%, with 2.65 ± 0.33 units transfused and a posttransfusion Hct increase of 5.0% ± 0.6%. Transfusion rates differed with PM (47.4%), SCAIF (17.2%), and SM (13.3%) flaps (P < 0.005). Patients undergoing PM reconstruction trended toward higher transfusion requirements (PM 2.89 ± 0.47 units, SC 2.18 ± 0.28 units, and SM 2.00 ± 0.0 units), with transfusion occurring later in the postoperative course (4.9 ± 1.3 days vs. 2.4 ± 0.1 days for all other flaps; P = 0.08). Infection, dehiscence, fistula, or medical complications were not different. Transfusion thresholds of Hct < 21 versus Hct < 27 exhibited no difference in LOS, flap-survival, or medical/flap-related complications.

Conclusion: Transfusion is not associated with surgical or medical morbidity following head and neck pedicled flap reconstruction. There were no differences in outcomes between transfusion triggers of Hct < 21 versus Hct < 27, suggesting that a more conservative transfusion trigger may not precipitate adverse patient complications. Our data recapitulate findings in free flap patients and warrant further investigation of transfusion practices in head and neck flap reconstruction.

Level Of Evidence: 4. Laryngoscope, 128:E409-E415, 2018.
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http://dx.doi.org/10.1002/lary.27393DOI Listing
December 2018

An Evaluation of the Program-Specific Paragraph in the Otolaryngology Residency Application.

Laryngoscope 2018 11 24;128(11):2508-2513. Epub 2018 Sep 24.

Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York.

Objectives/hypothesis: The recent addition of mandatory program-specific paragraphs within the personal statement during the otolaryngology match process has been controversial. It is unclear whether applicants customize these paragraphs for programs, or if they are largely uniform across applications. The objective of our study was to assess the degree of variability among program-specific paragraphs.

Study Design: Retrospective cohort analysis.

Methods: An analysis of deidentified program-specific paragraphs of 2016 otolaryngology residency applicants at two institutions was performed. Applicants who applied to both and had program-specific paragraphs were included. Paragraphs were assessed for 24 parameters, including quantitative content analysis. Subjective and objective similarity scores were assigned to each pair, using a five-point scale and Levenshtein distance function respectively. Differences between institutions were calculated using χ and two-sided t tests.

Results: Two hundred eight-five applications were reviewed, and 181 applied to both programs and had program-specific paragraphs. The median subjective similarity score among all paragraphs was "mildly similar" (2/5). The mean objective similarity score was 0.59. There were statistical differences between institutions in 13 parameters. One institution garnered more applicants who mentioned interest in research or global surgery (71.3% vs. 57.5%, P = .006; 17.7% vs. 4.4%, P < .0001, respectively), whereas the other attracted mention of clinical aspects and geographical ties (80.0% vs. 45.3%, P < .0001; 72.4% vs. 45.3%, P < .0001, respectively).

Conclusions: Our study suggests that applicants tailor program-specific paragraphs to the individual residency programs. These findings may aid programs and students in understanding the role of this new element of the application.

Level Of Evidence: 4 Laryngoscope, 2508-2513, 2018.
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http://dx.doi.org/10.1002/lary.27553DOI Listing
November 2018