Team-Based Surgical Scheduling for Improved Patient Access in a High-Volume, Tertiary Head and Neck Cancer Center.

BACKGROUND: Delays in care can lead to inferior survival outcomes in head and neck cancer and other cancers. In the case of malignancies for which surgery is the preferred primary treatment modality, challenges in surgical scheduling can present a major hurdle to initiating definitive therapy in a timely fashion. It is critical to maintain efficient use of operating room resources. Traditionally, surgery is scheduled with the surgeon who initially saw the patient in consultation, and timing of surgery is tightly linked to the availability and operating room block time of the individual surgeon. METHODS: Scheduling of oncologic head and neck surgery was transitioned from a surgeon-specific method to a team-based approach wherein a patient in need of oncologic head and neck surgery is scheduled with the next-available surgeon with appropriate expertise. RESULTS: Despite substantial growth of our practice, transition to a team-based scheduling approach allowed us to maintain high utilization of operating room block time. Patient and surgeon satisfaction remain high with this new system. CONCLUSIONS: A team-based surgical scheduling approach can help optimize operating room utilization and minimize delays in cancer care, potentially leading to improved oncologic outcomes.

Surgical Intervention for Peripheral Artery Disease Does Not Improve Patient Compliance with Recommended Medical Therapy.

BACKGROUND: Nonadherence to smoking abstinence, antiplatelet therapy, and statin therapy in patients with peripheral artery disease (PAD) is associated with worse long-term outcomes. We hypothesized that patients who underwent invasive revascularization procedures would be more likely to adhere to these therapies than patients who were managed medically. METHODS: Prospective survey-based interviews pertaining to medication and behavioral compliance of patients with symptomatic PAD were performed. Specifically, adherence to smoking cessation, antiplatelet therapy, and antilipid therapy was evaluated. A retrospective review of the electronic medical record was then performed to obtain procedural data and divide patients into medically managed or surgically managed (open revascularization, percutaneous revascularization, amputation) cohorts. RESULTS: One hundred patients met criteria for inclusion and took part in the study. Overall, 62% were nonsmokers, and 59.1% of those with a history of smoking had quit; 66.7% were adherent to statin therapy; and 72.7% were adherent to antiplatelet therapy. Among patients treated with or without surgery, respectively, there was no difference in regards to rates of smoking abstinence (64.8% vs. 55.2%, P = 0.37), successful smoking cessation (61.5% vs. 53.6%, P = 0.51), antiplatelet adherence (73.9% vs. 74.1%, P = 0.99), or statin adherence (65.2% vs. 70.4%, P = 0.24). Major amputation was also not associated with adherence to these therapies. CONCLUSIONS: Surgical revascularization does not influence the likelihood of adherence to smoking abstinence, smoking cessation, antiplatelet therapy, or statin therapy in patients with symptomatic PAD. Patients should be counseled regarding revascularization options with the understanding that their likelihood of medical treatment compliance will be unaffected by any proposed intervention.

Mandibular condylar hypoplasia in children with isolated unilateral congenital aural atresia.

OBJECTIVES/HYPOTHESIS: We hypothesized that children with isolated nonsyndromic unilateral congenital aural atresia have subclinical mandibular condylar hypoplasia ipsilateral to the atretic ear, and that the Jahrsdoerfer score is associated with the degree of condylar hypoplasia. STUDY DESIGN: Retrospective self-controlled case series. METHODS: We reviewed high-resolution computed tomography scans of the temporal bones of 68 children with isolated nonsyndromic unilateral congenital aural atresia. Images were viewed in the transverse (axial) plane perpendicular to the axis of the mandibular ramus and scanned from the mandibular notch to the condylar top. The slice where the condyle had the largest cross-sectional area was measured and checked for correlation with atresia status, age, and sex. The Jahrsdoerfer score of the atretic ear was calculated and correlated with condyle cross-sectional area, age, and sex. RESULTS: Cross-sectional area of the condyle ipsilateral to the atretic ear was, on average, 8.41 mm2 smaller than the contralateral condyle (P < .0001). The Jahrsdoerfer score was not associated with the condylar cross-sectional area, age, or sex. CONCLUSION: Isolated nonsyndromic unilateral congenital aural atresia is associated with mild hypoplasia of the mandibular condyle ipsilateral to the atretic ear. This is consistent with the hypothesis that congenital aural atresia is a variant of craniofacial (hemifacial) microsomia. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:1191-1195, 2018.

Jugular dominance is unrelated to isolated unilateral congenital aural atresia in children.

OBJECTIVES: The right jugular foramen is usually larger than the left in Homo sapiens, but it is unknown if right-sided jugular dominance is also more common amongst those with unilateral congenital aural atresia. We hypothesized that the dominant (i.e. larger) jugular foramen in children with isolated, non-syndromic, unilateral congenital aural atresia would be contralateral to the atretic ear. METHODS: We reviewed high-resolution computed tomography scans of the temporal bones of 70 children with isolated, non-syndromic, unilateral congenital aural atresia. Images were viewed in the transverse (axial) plane by a board-certified neuroradiologist and a board-certified otolaryngologist. Consensus opinion was recorded. Multiple logistic regression was used to assess the impact of age, sex, and side of aural atresia on jugular dominance. RESULTS: Jugular foramen dominance was not associated with the side of aural atresia (P = 0.20), age (P = 0.50) or sex (P = 0.76). Right-sided jugular dominance (46/70, 65.7%) was more common in both left- and right-sided unilateral aural atresia (P = 0.004). CONCLUSIONS: The side of jugular foramen dominance is not associated with the side of aural atresia in children with isolated, non-syndromic, unilateral congenital aural atresia. Right-sided jugular dominance is more common irrespective of unilateral aural atresia.

Inner ear anomalies in children with isolated unilateral congenital aural atresia.

OBJECTIVES/HYPOTHESIS: We aim to define the frequencies of anomalies of the inner ear, oval window, and round window ipsilateral to isolated non-syndromic unilateral aural atresia. METHODS AND MATERIALS: Retrospective case series. We reviewed high resolution computed tomography scans of the temporal bones of 70 children with isolated non-syndromic unilateral congenital aural atresia. Scans were reviewed according to the Jahrsdoerfer criteria and further evaluated for anomalies of the vestibule, semi-circular canals, cochlea, internal auditory canal and vestibulocochlear nerve. RESULTS: Inner ear dysplasia was seen in two of 70 atretic ears: one with a dysmorphic lateral semicircular canal and another with a large vestibule assimilating the lateral semicircular canal. Abnormalities of the oval window and round window ipsilateral to the atresia were identified in 21% (15) and 7% (5), respectively, of the atretic ears. Oval window and round window abnormalities were associated with disproportionately lower Jahrsdoerfer scores compared to aural atresia patients without these abnormalities (P < 0.001 and P = 0.04, respectively). CONCLUSION: Compared to studies that included syndromic or bilateral atresia cases, we found inner ear and oval window abnormalities less common in children with isolated non-syndromic unilateral aural atresia. However, round window anomalies seem to occur at about the same frequency.

Surgical Treatment of OSA on Cardiovascular Outcomes: A Systematic Review.

BACKGROUND: OSA is an increasingly prevalent clinical problem with significant effects on quality of life and cardiovascular risk. Surgical therapy represents an important treatment for those unable to use positive airway pressure. This systematic review examines the available cardiovascular risk reduction data for the surgical treatment of OSA. METHODS: A comprehensive literature search was performed. Articles were included if they met the following criteria: (1) the sample population consisted of adults (age ≥ 18 years); (2) OSA was diagnosed according to a sleep study; (3) surgical intervention was performed for OSA; and (4) one or more physical or biochemical cardiovascular and/or cerebrovascular variables was measured preoperatively and at ≥ 14 days postoperatively. RESULTS: Thirty-three articles were included. The majority of studies were case series and cohort studies (42% and 44%, respectively), with wide-ranging follow-up periods (4 weeks-9 years) and sample sizes (range, 6-10,339; median, 34). The following classes of surgical intervention were examined: pharyngeal surgery (n = 23), tracheostomy (n = 6), maxillomandibular advancement (n = 3), and hypoglossal nerve stimulation (n = 1). In total, 19 outcome measures were assessed. Tracheostomy was most consistently associated with improvement in cardiovascular end points. Pharyngeal surgeries (eg, uvulopalatopharyngoplasty) were variably associated with improvement in cardiovascular end points. CONCLUSIONS: The published literature examining cardiovascular end points following surgical treatment of OSA is limited and generally of poor quality. However, available data from mainly small and observational studies suggest that surgical treatment of OSA may provide improvement in some cardiovascular end points. Larger, randomized, and prospective trials with more rigorous study designs are needed. TRIAL REGISTRY: PROSPERO International Prospective Register of Systemic Reviews (PROSPERO 42016040120).