Worse Pituitary Adenoma Surgical Outcomes Predicted by Increasing Frailty, Not Age.

PURPOSE: Increasing patient age has been associated with worse outcomes after pituitary adenoma resection in previous studies, but the prognostic value of frailty compared with advancing age on pituitary adenoma resection outcomes has not been clearly evaluated. METHODS: The National Surgical Quality Improvement Program from 2015 to 2019 was queried for data for patients aged >18 years who underwent pituitary adenoma resection (n = 1454 identified patients). Univariate and multivariate analyses of age and frailty (5-factor modified frailty index [mFI-5]) were performed on 30-day mortality, major complications, extended length of stay (eLOS), discharge destination, and readmission and reoperation. The receiver operating characteristic curve analysis was performed to compare effect of age and mFI-5. RESULTS: On univariate analysis, increasing frailty was significantly associated with greater risk of unplanned readmission (frail: odds ratio [OR], 1.9; 95% confidence interval [CI], 1.2-3.2; severely frail: OR, 6.9; 95% CI, 2.4-19.8) and a major complication (frail: OR, 3.6; 95% CI, 2.1-6.1). Severe frailty was also associated with nonhome discharge (OR, 10.6; 95% CI, 3.2-35.8) and eLOS (OR, 4.5; 95% CI, 1.5-13.4). Increasing age was not associated with any of these outcome measures. Multivariate analysis also demonstrated similar trends. In receiver operating characteristic curve analysis, the mFI-5 score showed higher discrimination for major complications compared with age (area under the curve: 0.624 vs. 0.503; P < 0.001). CONCLUSION: Increasing frailty, and not advancing age, was an independent predictor for major complications, unplanned readmissions, eLOS, and nonhome discharge after pituitary adenoma resection, suggesting frailty to be superior to age in preoperative risk stratification in this patient population.

Comparing Videostroboscopy and Direct Microlaryngoscopy: An Argument for Flexible Consent and Operative Plan.

INTRODUCTION: Office-based evaluation of glottic lesions has progressed significantly, but there can still be discrepancies compared with direct microlaryngoscopy (DML) in the operating room. We performed a prospective evaluation comparing diagnosis of epithelial and lamina propria glottic lesions on rigid telescopic strobovideolaryngoscopy (RTS) with DML. METHODS: Fifty subjects were enrolled and underwent RTS followed by DML. We compared presence and extent (unilateral or bilateral) of lamina propria and epithelial lesions. Primary (diagnoses motivating an operation) and secondary (diagnoses not requiring an operation) were considered. Changes in diagnosis and operative plan based on DML findings were evaluated. RESULTS: Sixty-eight lesions were identified on RTS, including 53 primary (15 epithelial, 38 lamina propria) and 15 secondary diagnoses. RTS was accurate in only 36% of subjects. Ten subjects had a different primary pathology identified on DML. A change in surgical management occurred in 16% of subjects. CONCLUSIONS: This is the first prospective study evaluating how both diagnosis and operative plan for epithelial and lamina propria glottic lesions differ based on RTS and DML. Despite significant advances in office-based diagnosis of glottic lesions, there are still notable limitations. Clinicians should consider these findings when counseling patients on interpretation and plan for findings based on RTS. Obtaining a flexible surgical consent and counseling patients on the potential for new diagnoses and interventions based on DML is warranted.

Head and neck cancer screenings and human papillomavirus knowledge across diverse suburban and urban populations.

BACKGROUND: Minimal research has explored community dwelling adults' knowledge of the human papillomavirus (HPV) in relation to head and neck cancer (HNC). The purpose of this study was to report on community dwelling adults' knowledge of HPV in relation to infection, symptoms, and the development of HNC. METHODS: Cross-sectional assessment of community-dwelling adults on history of behavioral risk factors for HNC, health literacy, and knowledge regarding HPV in relation to HNC. RESULTS: Of those who completed the measure of health literacy, 17.1% read at or below an 8th grade level. Participants reported a range of history of behaviors putting them at increased risk for HPV and HNC. Respondents answered an average of 67.2% of HPV questions correctly, only one person answered all 15 questions correctly. There were no differences in knowledge of HPV in relation to HNC based upon demographics, suburban versus urban location, health literacy, or cancer history. CONCLUSIONS: Adults reported a range of behaviors associated with an increased risk of HPV transmission but also displayed large gaps in knowledge regarding HPV in relation to HNC.

National interdisciplinary rhinoplasty.

BACKGROUND: Rhinoplasty is a complex and multifaceted operation. There are great differences in methodologies between practitioners. Examining the preoperative, operative, and postoperative techniques employed by different practitioners will provide rhinoplasty surgeons with benchmarks by which they can evaluate their own practice. OBJECTIVE: To assess current trends in rhinoplasty surgery. METHODS: A comprehensive questionnaire was sent to 7368 members of the following societies: the American Society of Plastic Surgeons (ASPS), the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), and the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). Subgroup statistical analysis was performed. RESULTS: The overall response rate was 26%. Plastic surgeons accounted for 68% of the response rate and ear, nose, and throat-affiliated physicians accounted for 28%, with a small minority (4%) being members of both groups. Sixty-five percent of respondents have been in practice 11 or more years. Fifty-two percent of respondents are in private practice, 19% are in academic practice, and the rest are in single- or multispecialty practices. The number of rhinoplasties performed per year is spread fairly evenly up to 50 per year; however, only 9% of respondents perform 50 to 100 rhinoplasties per year, and only 5% perform more than 100 rhinoplasties per year. Most prefer the open approach over the closed approach, with 33% performing open only and 42% using both approaches, but primarily open. CONCLUSIONS: There is no uniform consensus regarding general rhinoplasty trends. Subanalysis shows that, overall, there are statistically significant similarities and differences amongst different specialties.

Surgical treatment of dysphagia.

The role of surgery in the management of dysphagia is clear in some areas and controversial in others. Evaluation for the causes of dysphagia can elucidate conditions in which surgery can improve safety, quality of life, or both. Surgical therapy, when indicated, is safe and effective for many causes of dysphagia. This article includes a general overview of the causes of dysphagia that can be addressed successfully with surgery as well as a discussion of why surgery may be less appropriate for other conditions associated with dysphagia.

Facial resurfacing of the male patient.

Cosmetic facial plastic procedures, surgical and nonsurgical alike, continue to increase in number. Recent statistics from the American Society of Aesthetic Plastic Surgery indicate that approximately 78% of the nearly 8.3 million cosmetic procedures performed in the United States each year are nonsurgical. Similar statistics have been demonstrated by the American Academy of Facial Plastic and Reconstructive Surgery who report that over the past 5 years there has been a 47% increase in nonsurgical procedures compared with a 19% increase in surgical procedures. The demographic of those seeking cosmetic procedures is dramatically changing also. Although cosmetic surgery was once predominantly sought by females, more and more male patients are now seeking treatment.