Ability of the National Surgical Quality Improvement Program Risk Calculator to Predict Complications Following Total Laryngectomy.

Importance: The accuracy of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) risk calculator has been assessed in multiple surgical subspecialties; however, there have been no publications doing the same in the head and neck surgery literature. Objective: To evaluate the accuracy of the calculator's predictions in a single institution's total laryngectomy (TL) population. Design, Setting, and Participants: Total laryngectomies performed between 2013 and 2014 at a tertiary referral academic center were evaluated using the risk calculator. Predicted 30-day outcomes were compared with observed outcomes for return to operating room, surgical site infection, postoperative pneumonia, length of stay, and venous thromboembolism. Main Outcomes and Measures: Comparison of the NSQIP risk calculator's predicted postoperative complication rates and length of stay to what occurred in this patient cohort using percent error, Brier scores, area under the receiver operating characteristic curve, and Pearson correlation analysis. Results: Of 49 patients undergoing TL, the mean (SD) age at operation was 59 (9.3) years, with 67% male. The risk calculator had limited efficacy predicting perioperative complications in this group of patients undergoing TL with or without free tissue reconstruction or preoperative chemoradiation or radiation therapy with a few exceptions. The calculator overestimated the occurrence of pneumonia by 165%, but underestimated surgical site infection by 7%, return to operating room by 24%, and length of stay by 13%. The calculator had good sensitivity and specificity of predicting surgical site infection for patients undergoing TL with free flap reconstruction (area under the curve, 0.83). For all other subgroups, however, the calculator had poor sensitivity and specificity for predicting complications. Conclusions and Relevance: The risk calculator has limited utility for predicting perioperative complications in patients undergoing TL. This is likely due to the complexity of the treatment of patients with head and neck cancer and factors not taken into account when calculating a patient's risk.

ACS NSQIP Risk Calculator: An Accurate Predictor of Complications in Major Head and Neck Surgery?

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator is meant to provide an estimation of perioperative risk. Our goal was to determine the clinical applicability of the calculator in major head and neck surgery. A retrospective chart review was completed for major head and neck operations performed at 1 institution from 2013 to 2014. The calculated perioperative complication risks from the ACS NSQIP calculator were compared with observed complication rates. Overall, the ACS NSQIP calculator had little predictive value for pneumonia, surgical site infection, 30-day return to operating room, or length of stay within this cohort (P > .05). The calculator appears to have some value predicting total numbers of complications but has poor performance predicting an individual's risk of suffering a perioperative complication. In conclusion, in our small cohort of patients, the ACS NSQIP calculator was a poor predictor of perioperative complications following major head and neck operations.

Short-term Peripheral Auditory Effects of Cranial Irradiation: A Mouse Model.

OBJECTIVES: Assess postcranial irradiation: (1) short-term threshold shift, (2) short-term peripheral auditory histopathology, and (3) the mouse as an experimental model. METHODS: Adult mice were exposed to single-dose radiation of 10 to 60 Gy. Pre- and post-irradiation (baseline, 2-8 days) audiometric brainstem response data were recorded with analysis of cochlear ultrastructure. RESULTS: Significant threshold shift occurred at all test frequencies in mice exposed to ≥20 Gy at 4 to 6 days post-irradiation. Ultrastructurally in Rosenthal's canal and the spiral lamina, neuronal density and extracellular matrix decreased dramatically. There was overall preservation of hair cells, stria vascularis, and vasculature. No difference within Gy group was noted in the frequency or severity of pathology along the length of the cochlea. CONCLUSIONS: The initial impact of radiation in the first week post-exposure focuses on spiral ganglion cell bodies and peripheral projections, resulting in significant threshold shift for irradiation dosages≥20 Gy. This study demonstrates that the mouse is a viable model for study of short-term peripheral auditory effects using single-dose cranial irradiation. Additionally, with access to a precise animal irradiator, the mouse may be used as an experimental model for a fractionated irradiation dosage of 10 Gy, simulating stereotactic therapeutic cranial irradiation.

Mycobacterium chelonae dacryocystitis after endoscopic dacryocystorhinostomy.

Mycobacterium chelonae is a rapidly growing nontuberculous Mycobacterium and an uncommon cause of aggressive, treatment-resistant ocular and periocular infection. This is the first known case report of a woman who developed unilateral M. chelonae dacryocystitis after undergoing endoscopic sinus surgery and right endoscopic dacryocystorhinostomy (DCR) with Crawford stent placement. We describe our findings and effective methods to manage the infection. Three weeks after undergoing DCR, the patient acutely developed symptoms consistent with dacryocystitis. The patient was treated with broad-spectrum antibiotics followed by incision and drainage of the dacryocystocele abscess, with initial cultures showing no organisms. With continued signs of infection, the Crawford stent was later removed. Cultures eventually grew M. chelonae and the patient was treated with 4 months of antibiotic therapy. While receiving antibiotics, the patient developed three abscesses along the inferior lid requiring excision. After 21 months, the patient remains free of infection and has not experienced any other complications. This case serves as a reminder to consider M. chelonae as a potential cause of periocular infection, which may be more likely to occur postoperatively with indwelling devices, as well as in patients with sinonasal issues requiring nasal irrigations. This organism can be difficult to treat because of multidrug resistance and biofilm production. Recommended therapy includes surgical debridement, removal of any implanted devices, and a two-drug antibiotic regimen for at least 4 months.

Single-stage repair of subglottic stenosis using the radial forearm free flap as a vascularized carrier.

BACKGROUND: We present a case report of a patient with history of subglottic carcinoma who underwent chemoradiation and subsequently developed subglottic stenosis (SGS). METHODS AND RESULTS: She was treated with an anterior cricoid split maintained by septal cartilage wrapped in a partially deepithelialized radial forearm free flap (RFFF). To date, with a follow-up of 6 months, the patient has been fully decannulated and has not experienced airway collapse or any other complications. CONCLUSIONS: Upper airway reconstruction using a single-stage autogenous cartilage graft wrapped in a vascularized carrier is a real option for those patients with extensive SGS in the setting of an irradiated and devascularized tissue bed.