Association of Age and Frailty With 30-Day Outcomes Among Patients Undergoing Oral Cavity Cancer Surgery.

OBJECTIVE: To evaluate the impact of age and frailty on 30-day outcomes following surgery for oral squamous cavity carcinoma (OSCC). STUDY DESIGN: Retrospective cross-sectional analysis. SETTING: American College of Surgeons' National Quality Improvement Program (NSQIP) database. METHODS: Patients who underwent OSCC resection were queried via NSQIP (2015-2020). Cases were stratified by age (18-65, 65-75, and older than 75) as well as by modified frailty index scores (mFI 0, mFI 1, and mFI 2+) for comparative analyses. Univariate and multivariable analyses were conducted to examine demographics, perioperative outcomes, and 30-day postoperative adverse events. RESULTS: A total of 3238 patients who underwent OSCC surgery were identified and categorized as nongeriatric ("NGA," age 18-65), younger geriatric ("YGA," age 65-75), and older geriatric ("OGA," age >75) adults. Compared to NGA, geriatric patients had higher the American Society of Anesthesiologists classification, higher modified frailty index scores, and more comorbidities such as hypertension, congestive heart failure, chronic obstructive disease, and diabetes (p < .001). YGAs and OGAs were also less likely to undergo neck dissection (p < .001), composite resection (p = .006), and free flap reconstruction compared to NGAs (p < .001). When controlling for confounders, age was not independently associated with an increased risk of poor outcomes. On the other hand, frailty was found to be independently associated with a higher risk of adverse events (odds ratio: 1.40 [1.15-1.70], p < .001 for mFI 1, odds ratio: 1.45 [1.04-2.02], p = .027 for mFI 2+). CONCLUSION: A higher mFI score, not older age, is associated with an increased risk of 30-day complications following OSCC surgery.

Surfing-Related Craniofacial Injuries: A NEISS Database Study.

INTRODUCTION: Surfing is a popular pastime in coastal areas around the world with increasing numbers of participants. There is a lack of detailed data in the literature regarding surfing-related head and neck (HN) injuries. MATERIALS AND METHODS: We queried the National Electronic Injury Surveillance System (NEISS) database to characterize patient demographics, injury types, injury subsite, and emergency department (ED) disposition status associated with surfing-related HN injuries between 2009 and 2020 in the United States. RESULTS: A total of 54,978 estimated national cases were reported from 2009 to 2020. Injuries to the head (36.0%) and neck (35.8%) were most common. Young adults (ages 18-35) made up most ED visits, whereas older adults (>35) made up most (63.5%) admissions. Laceration (46.1%) was the most common injury among ED visits, whereas fracture (30.5%) and internal injury (29.2%) were most common in admitted patients. Concussions represented 7.5% of injuries overall, 9.1% of pediatric injuries, and 9.9% of young adult injuries. CONCLUSIONS: When treating a patient who presents with injury suffered during surfing, a thorough examination of the HN should be performed. Specific attention should be given to evaluation of lacerations, fractures, internal ear injuries, and concussions. Pediatric and young adult patients are at increased risk of concussion. The majority of surfing injuries can be treated in an outpatient context.

Prolonged inpatient stay after upfront total laryngectomy is associated with overall survival.

OBJECTIVES: To investigate factors and complications associated with prolonged inpatient length of stay (LOS) in patients who receive total laryngectomy (TL), and to analyze its effect on short-term and long-term overall survival (OS). METHODS: The National Cancer Database (NCDB) was queried from 2004 to 2016 for patients with laryngeal cancer, who received TL within 60 days of diagnosis, and who had an inpatient LOS ≥1 night. Multivariable binary logistic regression and survival analyses on propensity score matched cohorts with Kaplan-Meier analysis and extended Cox regression were utilized. RESULTS: Eight thousand two hundred and ninety-eight patients from the NCDB were included. Median inpatient LOS was 8 days after TL (IQR: 7, 12). Prolonged LOS was defined as above the 75th percentile or 13 days or greater. On multivariable analysis, increasing patient age (OR 1.14 per 10 years, P = .003), female sex (OR 1.35, P < .001), and Charlson-Deyo comorbidity score of ≥2 compared to a score of 0 (OR 1.43, P < .001) were associated with prolonged LOS. Patients treated at high surgical case volume centers had a decreased likelihood for prolonged LOS (OR 0.67, P < .001). Ninety-day mortality increased over time in patients who stayed ≥13 days. Prolonged LOS was independently associated with worse OS on multivariable analysis (HR 1.40, 95% CI: 1.22, 1.61) in a matched cohort. CONCLUSIONS: Prolonged LOS after TL serves as a strong indicator for postoperative long-term mortality and may help identify patients who warrant closer surveillance. LEVEL OF EVIDENCE: 3.

The epidemiology, surgical management, and impact of margins in skull and mandibular osseous-site tumors.

OBJECTIVE: The aim of the study was to characterize the epidemiology and treatment outcomes of head and neck (HN) osseous-site tumors. METHODS: Descriptive analyses and multivariate Cox regressions were performed to analyze the effect of surgery on overall survival (OS) utilizing the National Cancer Database (2004-2016). RESULTS: Of 2449 tumors, surgery was utilized in 84.5% of cases. OS was worse in osteosarcoma (5-year OS: 53.4% [SE: 2.5%]) compared with cartilage tumors (5-year OS: 84.6% [SE: 1.8%]) (log-rank P < .001). Treatment regimens that included surgery were associated with improved OS on multivariate analysis (hazard ratio [HR] 0.495 [95% CI: 0.366-0.670]). Positive margins were found in 40.8% of cases, and associated with decreased OS in osteosarcomas (HR 1.304 [0.697-2.438]). CONCLUSION: Treatment that included surgery was associated with an increased OS within our cohort of HN osseous-site tumors, although the rates of positive margins were >40%. These findings may be limited by inherent selection bias in the database.