What makes working memory work? A multifaceted account of the predictive power of working memory capacity.

Working memory capacity (WMC) has received a great deal of attention in cognitive psychology partly because WMC correlates broadly with other abilities (e.g., reading comprehension, second-language proficiency, fluid intelligence) and thus seems to be a critical aspect of cognitive ability. However, it is still rigorously debated why such correlations occur. Some theories posit a single ability (e.g., attention control, short-term memory capacity, controlled memory search) as the primary reason behind WMC's predictiveness, whereas others argue that WMC is predictive because it taps into multiple abilities. Here, we tested these single- and multifaceted accounts of WMC with a large-scale (N = 974) individual-differences investigation of WMC and three hypothesized mediators: attention control, primary memory, and secondary memory. We found evidence for a multifaceted account, such that no single ability could fully mediate the relation between WMC and higher order cognition (i.e., reading comprehension and fluid intelligence). Further, such an effect held regardless of whether WMC was measured via complex span or n-back. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Medicare Advantage Prior Authorization Requirements for Otolaryngologic Procedures in 2021.

Little is known about the extent of prior authorization requirements in otolaryngology. We performed a secondary analysis of data comparing prior authorization (PA) policies across 5 major Medicare Advantage insurers to estimate the counterfactual proportion of 2021 Medicare Part B fee-for-service spending and utilization for commonly performed otolaryngologic procedures that would have required PA. The counterfactual proportion of spending (range: 20.4%-27.6%) and utilization (range: 1.8%-4.5%) requiring PA was relatively consistent across insurers and largely attributable to rhinologic procedures. However, PA requirements for specific services varied widely among insurers. Among the 70 (of 196; 35.7%) services subject to PA by any insurer, nearly half were subject to PA by a single insurer (n = 34; 48.6%). Only 10 (14.3%) services were subject to PA by 4 (n = 6; 8.6%) or 5 (n = 4; 5.7%) insurers. These discrepancies illustrate the challenges of navigating discordant insurer policies for otolaryngologists and raise concerns about the validity of certain PA requirements.

Patient factors associated with positive respiratory cultures following tracheostomy in pediatric patients.

OBJECTIVES: An increasing number of pediatric patients undergo tracheostomy placement annually. Despite advances in care, these patients remain at high risk for postoperative complications, including respiratory infections. The risk factors for positive respiratory cultures and the impact of culture positivity on overall morbidity and mortality in this population is not fully characterized. STUDY DESIGN AND SETTING: Retrospective cross-sectional analysis of all patients within a single tertiary care institution who underwent tracheostomy placement from January 1, 2019 to 12/31/2021. METHODS: We collected patient demographic information, comorbidities, primary indication for tracheostomy placement, and respiratory culture information preoperatively and postoperatively. The primary outcome measure was positive bacterial respiratory culture with speciation within 1, 3, or 6 months of tracheostomy placement. The secondary outcome measure was all-cause mortality within the study period. RESULTS: A total of 180 patients with median (IQR) age of 5.2 (3.4-31.0) months at time of tracheostomy placement were included in the study. Nearly half of patients had a positive culture within 1 month (n = 81,47.4 %) while 63.7 % of patients were positive within 6 months of tracheostomy placement (n = 109). Risk factors included respiratory and/or cardiac comorbidities. Positive respiratory cultures within 6 months of surgery and cardiac and/or neurologic comorbidities were associated with increased all-cause mortality following tracheostomy placement. CONCLUSIONS: Positive respiratory cultures are common following tracheostomy placement, more so in patients with cardiac and pulmonary comorbid conditions. Positive cultures are associated with increased all-cause mortality. More work is necessary to determine optimal screening frequency and treatment protocols for positive cultures in this population.

The importance of conative factors for individual differences in attention control.

Relations between conative factors (task-specific motivation, attention self-efficacy, and self-set goals) and individual differences in attention control (AC) performance were investigated in two latent variable studies. Participants performed AC tasks along with measures of working memory and processing speed. During the AC tasks, participants self-reported their motivation, self-efficacy, and self-set goals for the tasks. Task-unrelated thoughts were also assessed. Confirmatory factor analyses demonstrated that latent factors for the constructs could be formed and the conative factors were each related to the AC factor. Structural equation modeling further suggested that the conative factors tended to account for unique variance in attention, even after accounting for shared variance with working memory and processing speed. These results provide evidence that conative factors are important for individual differences in AC and further suggest that multiple factors likely contribute to variation in performance on AC tasks. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Which Provider Specialties are Performing Diagnostic Procedures for Dysphagia in the United States?

OBJECTIVE: Care of patients with dysphagia occurs at the intersection of several different medical specialties. Otolaryngologists are uniquely equipped to diagnose dysphagia given their specialized training, yet the extent to which otolaryngologists perform diagnostic procedures for dysphagia is unknown. The objective of this study was to characterize the specialty-level variation among providers performing diagnostic assessments for dysphagia. METHODS: We performed a retrospective, cross-sectional analysis of dysphagia care utilization among Medicare beneficiaries from 2013 to 2021 using the CMS Physician & Other Practitioners by Provider and Service dataset. American Association of Medical Colleges (AAMC) data reports were used to determine the total number of providers per specialty. For each procedure and specialty, the percentage of providers performing >10 procedures annually and the average annual number of procedures per performing provider (non-radiology) were calculated. RESULTS: We analyzed nine common dysphagia diagnostic procedures, including manometry, 24-h pH testing, flexible endoscopic evaluation of swallowing (FEES), and modified barium swallow study (MBSS). Mean 3.7 (SD 1.4) otolaryngologists (0.04% of practicing) performed manometry testing annually, compared to 493 (69.3) gastroenterologists (3.3%). Less than 1% of practicing otolaryngologists (37.8 (8.0) (0.04%)) and gastroenterologists (51.6 (8.4), 0.35%) performed 24-h pH testing annually. FEES testing was most commonly performed by otolaryngologists; however, only 48 (6.3) providers (0.51% of practicing) performed these procedures annually. For MBSS, fewer otolaryngologists (5.2 (1.0), 0.05%) perform these assessments than other medical specialties. Each otolaryngologist performed 110.7 (52.5) studies annually, compared to 200.1 (68.0) per gastroenterologist. CONCLUSION: Otolaryngologists represent a small fraction of providers performing dysphagia-related diagnostic procedures despite a unique training within our specialty to comprehensively diagnose and manage this condition. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:3698-3705, 2024.

An examination of individual differences in levels of processing.

The present study examined individual differences in levels of processing. Participants completed a cued recall task in which they made either rhyme or semantic judgements on pairs of items. Pupillary responses during encoding were recorded as a measure of the allocation of attentional effort and participants completed multiple measures of working and long-term memory. The results suggested levels of processing effect in both accuracy and pupillary responses with deeper levels of processing demonstrating higher accuracy and larger pupillary responses than shallower levels of processing. Most participants demonstrated levels of processing effect, but there was substantial variability in the size of the effect. Variation in levels of processing was positively related to individual differences in long-term memory and the magnitude of the pupillary levels of processing effect, but not working memory. These results suggest that some of the variation in levels of processing is likely due to individual differences in the allocation of attentional effort (particularly to items processed deeply) during encoding.

Individual differences in attention control: A meta-analysis and re-analysis of latent variable studies.

A meta-analysis and re-analysis of prior latent variable studies was conducted in order to assess whether there is evidence for individual differences in broad attention control abilities. Data from 90 independent samples and over 23,000 participants suggested that most (84.4%) prior studies find evidence for a coherent attention control factor with average factor loadings of .51. This latent attention control factor was related to other cognitive ability factors including working memory, shifting, fluid intelligence, long-term memory, reading comprehension, and processing speed, as well as to self-reports of task-unrelated thoughts and task specific motivation. Further re-analyses and meta-analyses suggest that the results remained largely unchanged when considering various possible measurement issues. Examining the factor structure of attention control suggested evidence for sub-components of attention control (restraining, constraining and sustaining attention) which could be accounted for a by a higher-order factor. Additional re-analyses suggested that attention control represents a broad ability within models of cognitive abilities. Overall, these results provide evidence for attention control abilities as an important individual differences construct.

Pulmonary and Clinical Outcomes After Bilateral Submandibular Gland Excision and Parotid Duct Ligation for Refractory Sialorrhea.

Importance: Refractory sialorrhea in children can result in pulmonary aspiration and irreversible lung damage. Despite many studies devoted to the surgical treatment of sialorrhea, there is a paucity of objective outcome measures after surgery, especially with regard to pulmonary health. Objectives: To assess whether bilateral submandibular gland excision and bilateral parotid duct ligation ("DROOL" procedure) is associated with reduced pulmonary inflammation in bronchoalveolar lavage (BAL) samples after surgery and to assess patient factors associated with improvement after surgery. Design, Setting, and Participants: This retrospective case series included all 112 patients undergoing the DROOL procedure at a single tertiary care pediatric children's hospital from January 1, 2012, to December 31, 2021. Statistical analysis was performed from March 30 to June 10, 2023, and August 20 to September 23, 2023. Exposure: DROOL procedure for refractory sialorrhea. Main Outcomes and Measures: Degree of pulmonary inflammation (neutrophil percentage) according to BAL cytologic findings and overall bronchoscopy findings up to 12 months before and after the DROOL procedure. Secondary outcomes included number of annual hospitalizations, caregiver report of function before and after the procedure, and need for revision procedures and/or additional operations for secretion management. Results: A total of 112 patients (median age, 3.4 years [IQR, 2.0-7.1 years]; 65 boys [58.0%]) underwent DROOL procedures and had both preoperative and postoperative BAL samples during the study period. Patients demonstrated objective improvement in pulmonary inflammation after surgery, with the median polymorphonuclear neutrophil percentage decreasing from 65.0% (IQR, 14.0%-86.0%) before the surgery to 32.5% (IQR, 3.0%-76.5%) after the surgery (median difference in percentage points, -9.0 [95% CI, -20.0 to 0.0]). Prior to the DROOL procedure, 34 patients (30.4%; 95% CI, 21.8%-38.9%) were hospitalized 2 or more times annually for respiratory illness, which decreased to 10.1% (11 of 109; 95% CI, 4.4%-15.7%) after surgery (3 patients did not have hospitalization data available following surgery). Most caretakers (73 [65.2%]) reported improved secretion management after the procedure. Conclusions and Relevance: This study suggests that patients with impaired secretion management who underwent a DROOL procedure demonstrated improvement in pulmonary inflammation and a reduction in hospitalizations after surgery. Caretakers were also likely to report subjective improvement in secretion management and quality of life. Additional research is necessary to guide optimal timing and patient selection for this procedure.

Predictive Value of Laryngeal Penetration to Aspiration in a Cohort of Pediatric Patients.

Videofluoroscopic swallow studies (VFSS) provide dynamic assessment of the phases of swallowing under fluoroscopic visualization and allow for identification of abnormalities in the process, such as laryngeal penetration and aspiration. While penetration and aspiration both reflect degrees of swallowing dysfunction, the predictive potential of penetration for subsequent aspiration is not fully elucidated in the pediatric population. As a result, management strategies for penetration vary widely. Some providers may interpret any depth or frequency of penetration as a proxy for aspiration and implement various therapeutic interventions (e.g., modification of liquid viscosity) to eliminate penetration episodes. Some may recommend enteral feeding given the presumed risk of aspiration with penetration, even when aspiration is not identified during the study. In contrast, other providers may advise continued oral feeding without modification even when some degree of laryngeal penetration is identified. We hypothesized that the depth of penetration is associated with the likelihood of aspiration. Identification of predictive factors for aspiration following laryngeal penetration events has significant implications for selection of appropriate interventions. We performed a retrospective cross-sectional analysis of a random sample of 97 patients who underwent VFSS in a single tertiary care center over a 6 month period. Demographic variables including primary diagnosis and comorbidities were analyzed. We examined the association between aspiration and degrees of laryngeal penetration (presence or absence, depth, frequency) across diagnostic categories. Infrequent and shallow penetration events of any type of viscosity were less likely to be associated with aspiration event(s) during the same clinical encounter regardless of diagnosis. In contrast, children with consistent deep penetration of thickened liquids invariably demonstrated aspiration during the same study. Our findings show that shallow, intermittent laryngeal penetration of any viscosity type on VFSS was not consistent with clinical aspiration. These results provide further evidence that penetration-aspiration is not a uniform clinical entity and that nuanced interpretation of videofluoroscopic swallowing findings is necessary to guide appropriate therapeutic interventions.

Pupillary correlates of preparatory control in the Stroop task.

In three experiments, individual differences in preparatory control in the Stroop task were examined. Participants performed variants of the Stroop task while pupillary responses were examined during the preparatory interval. Variation in working memory capacity was also examined. High Stroop performers tended to demonstrate larger preparatory pupillary responses than low Stroop performers. In Experiment 2, when participants were given pre-cues indicating the congruency of the upcoming trial (MATCHING vs. CONFLICTING), high Stroop performers had larger preparatory pupillary responses for incongruent trials compared to congruent trials, whereas low Stroop performers demonstrated similar preparatory pupillary responses on both incongruent and congruent trials. These results suggest that variation in Stroop performance is partially due to individual differences in the ability to ramp up and regulate the intensity of attention allocated to preparatory control processes. Additionally, there was limited evidence that preparatory control processes partially account for the relation between working memory capacity and performance on the Stroop. Overall, these results provide evidence that individual differences in Stroop performance are partialy due to variation in preparatory control.

Hospital Prices for Pediatric Tympanostomy Tube Placement and Adenotonsillectomy in 2021.

OBJECTIVES: Hospital prices vary substantially for myringotomy with tympanostomy tube placement (M&T) and adenotonsillectomy (T&A). The Centers for Medicare and Medicaid Services recently implemented hospital price transparency requirements to help families make financially informed decisions about where to seek care. We sought to determine price availability and the extent of price variation for these procedures. METHODS: We performed a cross-sectional analysis of the Turquoise Health Hospital Rates Data Platform, which extracts prices for facility fees from publicly available hospital chargemasters. We determined the proportion of hospitals serving pediatric patients that published payer-specific prices for M&T and T&A. We additionally characterized the extent of variation in payer-specific prices both across and within hospitals. RESULTS: Approximately 40% (n = 909 of 2,266 hospitals) serving pediatric patients disclosed prices for M&T or T&A. Among disclosing hospitals, across-center ratios (adjusted for Medicare hospital wage indices) ranged from 11.0 (M&T; 10th percentile adjusted median price: $536.80 versus 90th percentile adjusted median price: $5,929.93) to 23.4 (revision adenoidectomy age >12 years; 10th percentile: $393.82 versus 90th percentile: $9,209.88). Median within-center price ratios for procedures ranged from 2.2 to 2.7, indicating that some private payers reimbursed the same hospital more than twice as much as other payers for the same procedure. CONCLUSION: The majority of hospitals serving pediatric patients were non-compliant with federal requirements to disclose prices for M&T and T&A. Among disclosing hospitals, there was wide variation in payer-specific prices between and within institutions. Further research is necessary to understand whether disclosure of prices will enable families to make more financially informed decisions. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:948-955, 2023.

Compensation Rates for Pediatric Otolaryngology Procedures Under the Medicare Physician Fee Schedule in 2021.

INTRODUCTION: The Medicare Physician Fee Schedule (PFS) is the basis for physician reimbursement by public and private payers. The PFS values physician services according to the estimated time and intensity required to perform them; intensity reflects the summation of technical skill, cognitive load, and risk-related stress. The fee schedule uses relative value units (RVUs) as a metric that permits comparison across procedures. Recent debate has focused on whether the methods by which the Centers for Medicare & Medicaid Services (CMS) estimate procedural intensity are valid. We therefore sought to investigate current CMS estimates of intensity (RVUs/min) for surgical procedures performed by pediatric otolaryngologists. METHODS: We performed a retrospective, cross-sectional analysis of fiscal year 2021 PFS valuations for pediatric otolaryngology key indicator procedures specified by the Accreditation Council for Graduate Medical Education. We additionally examined general otolaryngology procedures, including adenotonsillectomy and tympanostomy tube insertion. We utilized the 2021 Medicare PFS conversion factor of $34.89/RVU to convert intensity (wRVUs/min) to a compensation rate ($/min). Primary outcomes were: (1) total compensation rate and (2) intraservice (i.e., incision-to-closure) compensation rate for each studied procedure. RESULTS: Our study sample included 167 unique procedures. The mean (standard deviation) total compensation rate for all included procedures was $1.35/min ($0.29/min) and the mean intraservice rate was $1.71/min ($0.89/min). Intraservice compensation rates ranged from $-1.50/min (drainage of throat abscess) to $4.75/min (pediatric tracheostomy). DISCUSSION: Total and intraservice compensation rates under the Medicare PFS vary widely for surgical procedures performed by pediatric otolaryngologists. Further investigation is necessary to examine the validity of assumptions underlying these procedural intensity valuations. LEVEL OF EVIDENCE: NA Laryngoscope, 133:1739-1744, 2023.

Oculometric indicators of individual differences in preparatory control during the antisaccade task.

Individual differences in preparatory control in the antisaccade task were examined in two experiments via an examination of pupillary responses and fixation stability during the preparatory delay. In both experiments, high attention control individuals (high-antisaccade performers) demonstrated larger pupillary responses during the preparatory delay than low attention control individuals (low-antisaccade performers). These results suggest that variation in antisaccade performance were partially due to individual differences in the ability to ramp up and regulate the intensity of attention allocated to preparatory control processes. Additionally, fixation stability, working memory capacity, susceptibility to off-task thinking, and task-specific motivation were found to correlate with antisaccade performance. Furthermore, both preparatory control and off-task thinking accounted for much of the relation between working memory capacity and antisaccade. These results provide evidence that individual differences in antisaccade performance are multifaceted and that variation in preparatory control (along with other factors) are critically important. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Self-expansion is positively associated with Fitbit-measured daily steps across 4-weeks.

The growth of the self-concept through increasing perspectives, identities, resources, and efficacy is known as self-expansion and typically involves novelty, challenge, interest, and/or excitement. Self-expansion is positively associated with health factors including self-reported physical activity (PA). This study is the first to investigate self-expansion and daily PA, and with a PA monitor. Fifty community participants completed baseline questionnaires, wore a Fitbit One and completed daily self-report questionnaires for 28 days, and completed follow-up questionnaires. Daily surveys included questions about both general and PA-specific self-expansion. Across the 4 weeks, steps taken was positively correlated with both general (all maximum likelihood r = 0.17) and PA-specific self-expansion (maximum likelihood rs of 0.15 and 0.16), and PA-specific self-expansion was positively correlated (maximum likelihood rs of 0.38 and 0.50) with aerobic activity. Future research should investigate this relationship in a larger more diverse sample and test whether PA-specific self-expansion can be utilized as an acceptable, feasible, and effective intervention to increase daily steps and other forms of PA.

The influence of working memory capacity and lapses of attention for variation in error monitoring.

In two experiments, individual differences in working memory capacity (WMC), lapses of attention, and error monitoring were examined. Participants completed multiple WMC tasks along with a version of the Stroop task. During the Stroop, pupil diameter was continuously monitored. In both experiments, error phasic pupillary responses were larger than phasic pupillary responses associated with correct incongruent and correct congruent trials. WMC and indicators of lapses of attention were correlated with error pupillary response, suggesting that high WMC and low lapse individuals had enhanced error monitoring abilities compared with low WMC and high lapse individuals. Furthermore, in Experiment 2 error awareness abilities were associated with WMC, lapses of attention, and the error phasic pupillary responses. Importantly, individual differences in the susceptibility to lapses of attention largely accounted for the relationship between WMC and error monitoring in both experiments. Collectively, these results suggest that WMC is related to error monitoring abilities, but this association is largely due to individual differences in the ability to consistently maintain task engagement and avoid lapses of attention.

On the relation between working memory capacity and the antisaccade task.

Eight experiments (N = 2,003) assessed the relation between working memory capacity (WMC) and performance on the antisaccade task. Experiments 1-5 and 7 examined individual differences in aspects of goal management processes occurring during the preparatory delay of the antisaccade task. WMC tended to interact with delay interval suggesting that high WMC individuals better prepared for the upcoming trial by activating the task goal to a higher level than low WMC individuals (although these effects were generally small). Experiments 3a, 4, and 7 further demonstrated that individual differences in the consistency of attention (i.e., lapses of attention) were partially important for the relation between WMC and antisaccade performance. Experiment 5 demonstrated that knowledge of the likelihood of target location increased overall performance, but did not interact with WMC. Experiment 6 manipulated stimulus onset asynchrony and suggested that speed factors are also likely important for the relation between WMC and antisaccade performance. Finally, structural equation models in Experiment 7 suggested that lapses of attention and speed factors partially accounted for the relation between WMC and antisaccade, but WMC still accounted for unique variance in antisaccade. Collectively, the results suggest that multiple factors (goal activation, consistency of attention, and speed factors) contribute to the relation between variation in WMC and performance on the antisaccade task. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Utility of a Novel Definition of Health Care Regions in the United States in the Era of COVID-19: A Validation of the Pittsburgh Atlas Using Pneumonia Admissions.

STUDY OBJECTIVE: The COVID-19 pandemic in the United States has underscored the need to understand health care in a regional context. However, there are multiple definitions of health care regions available for conducting geospatial analyses. In this study, we compare the novel Pittsburgh Atlas, which defined regions for emergency care, with the existing definitions of regions, counties, and the Dartmouth Atlas, with respect to nonemergent acute medical conditions using pneumonia admissions. METHODS: We identified patients hospitalized with a primary diagnosis of pneumonia or a primary admitting diagnosis of sepsis with a secondary diagnosis of pneumonia in the Agency for Healthcare Research and Quality's State Inpatient Databases. We calculated the percentage of region concordant care, the localization index, and market share for 3 definitions of health care regions (the Pittsburgh Atlas, Dartmouth Atlas, and counties). We used logistic regression identified predictors of region concordant care. RESULTS: We identified 1,582,287 patients who met the inclusion criteria. We found that the Pittsburgh Atlas and Dartmouth Atlas definitions of regions performed similarly with respect to both localization index (92.0 [interquartile range 87.9 to 95.7] versus 90.3 [interquartile range 81.4 to 94.5]) and market share (8.5 [interquartile range 5.1 to 13.6] versus 9.4 [interquartile range 6.7 to 14.1]). Both atlases outperformed the localization index (67.5 [interquartile range 49.9 to 83.9]) and market share (20.0% [interquartile range 11.4 to 31.4]) of the counties. Within a given referral region, the demographic factors, including age, sex, race/ethnicity, insurance status, and the level of severity, affected concordance rates between residential and hospital regions. CONCLUSION: Because the Pittsburgh Atlas also has the benefit of respecting state and county boundaries, the use of this definition may have improved policy applicability without sacrificing accuracy in defining health care regions for acute medical conditions.

Effort Mobilization and Lapses of Sustained Attention.

The current study examined whether effort mobilization would enhance sustained attention and reduce lapses of attention. Participants performed a sustained attention task and were randomly assigned to either an effort condition where they were instructed to "Try Hard" on a subset of trials or were assigned to a control condition with no "Try Hard" instructions. Pupillary responses were continuously recorded, and periodically during the task participants were presented with thought probes to determine whether they were on or off task. The results suggested within the effort condition there were no behavioral differences between Try Hard and "Standard" trials. Preparatory pupil responses were increased in Try Hard trials, but there were no differences for phasic pupillary responses to stimulus onset. In contrast, examining differences between the effort and control conditions suggested that participants who received the Try Hard instructions demonstrated faster overall performance, a reduction in very long reaction times, and reported fewer off-task thoughts compared with participants in the control condition. Participants in the effort condition also demonstrated a larger ramp-up in pupillary responses during the preparatory interval and a larger phasic response to stimulus onset compared with participants in the control condition. These results are consistent with attention allocation models suggesting that participants in the effort condition mobilized more attentional effort than participants in the control condition, resulting in enhanced sustained attention and a reduction in lapses of attention. These results also are consistent with recent theories, which suggest that the locus coeruleus norepinephrine system is associated with effort mobilization.

Assessment of Preoperative Functional Status Prior to Major Head and Neck Surgery: A Pilot Study.

OBJECTIVE: To demonstrate feasibility of a recently developed preoperative assessment tool, the Vulnerable Elders Surgical Pathways and Outcomes Analysis (VESPA), to characterize the baseline functional status of patients undergoing major head and neck surgery and to examine the relationship between preoperative functional status and postoperative outcomes. STUDY DESIGN: Case series with planned data collection. SETTING: Two tertiary care academic hospitals. METHODS: The VESPA was administered prospectively in the preoperative setting. Data on patient demographics, ablative and reconstructive procedures, and outcomes including total length of stay, discharge disposition, delay in discharge, or complex discharge planning (delay or change in disposition) were collected via retrospective chart review. VESPA scores were calculated and risk categories were used to estimate risk of adverse postoperative outcomes using multivariate logistic regression for categorical outcomes and linear regression for continuous variables. RESULTS: Fifty-eight patients met study inclusion criteria. The mean (SD) age was 66.4 (11.9) years, and 58.4% of patients were male. Nearly one-fourth described preoperative difficulty in either a basic or instrumental activity of daily living, and 17% were classified as low functional status (ie, high risk) according to the VESPA. Low functional status did not independently predict length of stay but was associated with delayed discharge (odds ratio [OR], 5.0; 95% CI, 1.2-21.3; P = .030) and complex discharge planning (OR, 5.7; 95% CI, 1.34-24.2; P = .018). CONCLUSION: The VESPA can identify major head and neck surgical patients with low preoperative functional status who may be at risk for delayed or complex discharge planning. These patients may benefit from enhanced preoperative counseling and more comprehensive discharge preparation.