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Objectives: Patients undergoing head and neck free flap reconstruction (HNFFR) may have significant change to their baseline functional status requiring inpatient rehabilitation (IPR) after discharge. We sought to identify patient/procedure characteristics predictive of discharge destination. Methods: Patients undergoing elective HNFFR between July 2017 and July 2022 were reviewed for discharge destination. Those discharged to IPR versus home were compared across patient/procedure characteristics and physical/occupational therapy metrics. Significance was assessed via bivariate and multivariable analyses. Results: Of the 531 patients, 102 (19.2%) required IPR postoperatively. Patients discharged to IPR versus home were significantly older (70.1 [11.6] vs. 64.1 [13.1] years; p < 0.001) and more likely to lack family assistance (26.5% vs. 8.6%; p < 0.001), require baseline assistance for activities of daily living (ADLs) (31.4% vs. 9.8%; p < 0.001), have baseline cognitive dysfunction (15.7% vs. 6.1%; p = 0.001), were more likely to have neoplasm as the surgical indication for HNFFR (89.2% vs. 80.0%; p = 0.033) and more likely to have a tracheostomy postop (62.7% vs. 51.7%), and had a significantly longer length of stay (11.2 [8.0] vs. 6.8 [8.3] days; p < 0.001). There was no significant difference in gender, donor site, use of tube feeds, and use of assistive devices between the two groups. Following logistic regression, the strongest predictors of discharge to IPR include lack of family assistance (OR = 3.8; p < 0.001) and baseline assistance for ADLs (OR = 4.0, p < 0.001). Conclusion: Certain patient factors predict the need for discharge to rehab after HNFFR. Perioperative identification of these factors may facilitate patient counseling and discharge planning with potential to reduce hospital length of stay and further optimize patient care. Level of Evidence: III Laryngoscope, 134:2721–2725, 2024 [ABSTRACT FROM AUTHOR]

Objective: Maxillomandibular advancement (MMA) is an effective surgical treatment for obstructive sleep apnea (OSA); however, it is unclear how many patients who are referred for MMA actually undergo surgery. This study aims to determine follow‐up rates for patients referred for MMA and the reasons behind their choices. Methods: Via retrospective review, we assessed consecutive patients with OSA intolerant to continuous positive airway pressure (CPAP) who underwent drug induced sleep endoscopy (DISE) between 2018 and 2020 at our institution. Patients recommended for MMA based on DISE and other findings were included. Patients were then contacted and administered an IRB‐approved survey in present time. Results: One hundred and fifty nine patients were referred to oral maxillofacial surgery (OMFS) for MMA consult. Seventy seven patients (48%) followed up with OMFS and 29 (18%) underwent MMA. Sixty two (40%) patients resumed CPAP. Fifty eight patients (36.5%) were lost to follow up. Seventy three patients (46%) completed our survey. Of those patients, 37 (51%) followed up with OMFS and 17 (23%) underwent MMA. Patients who did not follow up with OMFS cited the invasiveness of the surgery (39%), recovery time (17%), or both (31%) as reasons. Those who pursued consultation cited inability to tolerate CPAP (73%), not being a candidate for inspire (14%), and desire to learn about alternative treatments (14%) as reasons. Of those who did not undergo MMA, 28.6% are not using OSA treatment. Conclusion: Less than half of patients referred for MMA followed up, and less than half of those patients underwent MMA. Most patients cited concerns about the invasiveness of the surgery and recovery process. Level of Evidence: 4 Laryngoscope, 134:2964–2969, 2024 [ABSTRACT FROM AUTHOR]

Objectives: There is little research on the rate and risk factors for revision tonsillectomy after primary intracapsular tonsillectomy. Our study aimed to determine the revision rate following intracapsular tonsillectomy, identify patient characteristics that may increase the probability of revision surgery, and report the tonsillar hemorrhage rate after revision. Study Design: Level III, retrospective case-control study. Setting: A tertiary care pediatric center (Alfred I. duPont Hospital for Children, Wilmington, Delaware). Methods: A case-control study of pediatric patients who underwent intracapsular tonsillectomy between January 1, 2004, and December 31, 2018, was performed. Patients aged 2 to 20 years were analyzed and compared with matched controls who underwent intracapsular tonsillectomy within 7 days of the same surgeon's case. In total, 169 revision procedures were included with 169 matched controls. Results: A 1.39% revision rate was observed among a total of 12,145 intracapsular tonsillectomies. Among the 169 patients who underwent a revision procedure, the mean time between cases was 3.5 years. Tonsillitis was the most common diagnosis prompting revision tonsillectomy. Four (2.4%) patients underwent operative control of a postoperative tonsillar hemorrhage after revision surgery. Younger patients (P <.001) and patients with a history of gastroesophageal reflux disease (P =.006) were more likely to undergo revision tonsillectomy. Conclusion: Patients below age 4 years and patients with gastroesophageal reflux disease may be at increased risk of undergoing revision tonsillectomy after primary intracapsular tonsillectomy. These factors should be considered when selecting an intracapsular technique for primary tonsillectomy in pediatric patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate if a history of venous thromboembolism (VTE) is a risk factor for complications in head and neck free flap surgery by assessing outcomes among patients with a history of deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Study Design: Retrospective cohort study. Setting: Single tertiary care center. Methods: All patients undergoing head and neck free flap reconstruction at our institution between September 1, 2006, and April 2, 2020, were assessed for inclusion. Patients with and without a history of DVT or PE preoperatively were identified and grouped for comparison. Groups were compared for demographics, comorbidities, and 30-day complications. Significance was assessed with chi-square and binary logistic regression analyses. Results: Of the 1061 patients meeting inclusion criteria, 40 (3.8%) had a history of VTE. These patients were significantly older (mean [SD], years: 67.8 [11.7] vs 63.0 [14.1], P =.038) and significantly more likely to have history of chemotherapy (35.0% vs 18.7%, P =.010) and stroke (27.5% vs 4.5%, P <.001). After accounting for patient characteristics via binary logistic regression, VTE was independently associated with an increased risk for postoperative thrombosis of the free flap pedicle (odds ratio [95% CI] = 3.65 [1.12-11.90], P =.032) and reoperation (2.45 [1.25-4.80], P =.009). Patients with history of PE had a significantly increased risk for flap failure (7.70 [1.77-33.52], P =.007). Prior VTE was not independently associated with an increased risk for medical complications or readmission. Conclusion: Patients with a history of VTE may be at an increased risk for free flap compromise secondary to postoperative pedicle thrombosis. This risk should be considered in preoperative workup and postoperative monitoring. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To investigate the risk factors for refusal of recommended surgery in head and neck squamous cell carcinoma (HNSCC) treatment STUDY DESIGN: Retrospective review of a national database.Methods: The Surveillance, Epidemiology, and End Results database was queried for all cases of HNSCC from 1989 to 2014. Patients who underwent recommended surgery (N = 98,270) were identified and compared to patients who refused recommended surgery (N = 3,582). Groups were compared for patient demographics, socioeconomic variables, and tumor characteristics including stage, grade, and primary site. Binary logistic regression was performed to determine independent predictors of surgery refusal.Results: Of the total population, 1.8% of patients refused cancer directed surgery. Following regression, the strongest predictors of surgery refusal were found to be age greater than 75years (odds ratio [OR]: 4.23 [95% confidence interval {CI}: 3.00-5.96]), and stage III (OR: 4.19 [95% CI: 3.15-5.57]) or stage IV at diagnosis (OR: 4.49 [95% CI: 3.46-5.80]). Black race was significantly predictive (OR: 1.71 [95% CI: 1.37-2.13]) as well as marital status other than married (OR: 1.76 [95% CI: 1.49-2.07]) and Medicaid insurance status (OR:1.46 [95% CI: 1.20-1.77]). Primary site of larynx (OR: 2.01 [95% CI: 1.71-2.37]) or base of tongue (OR: 2.34 [95% CI: 1.87-2.92]) additionally predicted surgery refusal.Conclusions: A number of demographic, socioeconomic, and tumor-related variables are associated with refusal of cancer-directed surgery in head and neck squamous cell carcinoma. Recognition of these factors may help identify situations where more active education and support are needed to help patients accept optimal care.Level Of Evidence: 4 Laryngoscope, 129:1368-1373, 2019. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Analyze the characteristics of second primary lung malignancies (SPLMs) following an index head and neck squamous cell carcinoma (HNSCC).Study Design: Retrospective cohort study.Methods: The Surveillance, Epidemiology and End Results database was queried for all cases of HNSCC between 1973 and 2014 (N = 101,856). This population was compared to a standard population to assess relative risk for lung cancer, calculated as the standardized incidence ratio (SIR). Patients who developed SPLMs were extracted (N = 8,116) and compared to all other cases of lung cancer (N = 1,160,853) to assess histopathological differences. SPLM subpopulations divided by head and neck primary site were compared for lung cancer histology and time interval between cancer diagnoses.Results: Overall, 8.0% of HNSCC patients developed SPLMs (SIR = 4.22, P < .001), diagnosed an average of 6.7 years later. Patients with HNSCC of the supraglottis and hypopharynx were at the highest risk relative to a standard population, with SIRs of 8.10 and 6.34, respectively. When comparing SPLMs to all other lung cancers, there was no difference in the distribution of lung lobe affected, but SPLMs were significantly more likely to be of squamous cell carcinoma histology (42.0% vs. 21.0%, P < .001). Among head and neck subsites, lung cancers following larynx tumors had a significantly higher proportion of small cell histology, and those following oropharyngeal or hypopharyngeal tumors had significantly higher proportions of squamous cell histology.Conclusions: Patients who undergo curative treatment of HNSCC are at high risk for developing SPLMs. Subsite-specific differences may help elucidate the degree of risk attributable to smoking, genetic susceptibility, human papillomavirus infection, or metastasis masquerading as an SPLM.Level Of Evidence: 4 Laryngoscope, 129:903-909, 2019. [ABSTRACT FROM AUTHOR]