Central Skull Base Osteomyelitis: A Case Series from a Tertiary Care Center Over 5 Years.

OBJECTIVE: Skull base osteomyelitis may rarely present in the sphenoid bone or clivus without an otologic source. This is referred to as central skull base osteomyelitis (CSBO). Knowledge regarding CSBO is limited to case reports and small case series. Here we present a case series to further describe typical patient characteristics, clinical presentation, and clinical course associated with this rare infection. METHODS: All patients treated at a single academic tertiary care institution for CSBO from 2016 through 2020 were identified. Inclusion criteria included culture proven CSBO without an otologic or iatrogenic source. Data were extracted via patient chart review and qualitatively analyzed. RESULTS: Seven patients were identified with CSBO, 5 male and 2 female. Age ranged from 63 to 87 (average 76). Risk factors included advanced age, diabetes, and history of radiation. The most common presenting symptom was headache (6), followed by otalgia (4). Two patients presented with cranial neuropathies. Diagnosis was facilitated by history and exam (including flexible laryngoscope exam), imaging (MRI), and labs (ESR). All patients received endoscopic biopsy and culture (most commonly polymicrobial, with diverse species). Treatment involved IV antibiotics, with a limited role for surgery. All patients survived and achieved resolution of infection. CONCLUSIONS: CSBO remains a diagnostic challenge due to its rarity and vague presenting symptoms that overlap with presentation of sinonasal malignancies. A high index of suspicion is required by the evaluating provider to ensure a timely diagnosis with early treatment in order to limit the significant morbidity which can be associated with this infection. LEVEL OF EVIDENCE: 4.

HuR-Targeted Inhibition Impairs Th2 Proinflammatory Responses in Asthmatic CD4+ T Cells.

RNA-binding protein HuR (ELAVL1) is a master regulator of gene expression in human pathophysiology. Its dysregulation plays an important role in many diseases. We hypothesized that HuR plays an important role in Th2 inflammation in asthma in both mouse and human. To address this, we used a model of airway inflammation in a T cell-specific knockout mouse model, distal lck-Cre HuRfl/fl, as well as small molecule inhibitors in human peripheral blood-derived CD4+ T cells. Peripheral CD4+ T cells were isolated from 26 healthy control subjects and 45 asthmatics (36 type 2 high and 9 non-type 2 high, determined by blood eosinophil levels and fraction of exhaled NO). Our mouse data showed conditional ablation of HuR in T cell-abrogated Th2 differentiation, cytokine production, and lung inflammation. Studies using human T cells showed that HuR protein levels in CD4+ T cells were significantly higher in asthmatics compared with healthy control subjects. The expression and secretion of Th2 cytokines were significantly higher in asthmatics compared with control subjects. AMP-activated protein kinase activator treatment reduced the expression of several cytokines in both type 2 high and non-type 2 high asthma groups. However, the effects of CMLD-2 (a HuR-specific inhibitor) were more specific to endotype-defining cytokines in type 2 high asthmatics. Taken together, these data suggest that HuR plays a permissive role in both allergen and non-allergen-driven airway inflammation by regulating key genes, and that interfering with its function may be a novel method of asthma treatment.

Virtual Resident Mentorship Groups for Fourth Year Medical Students Applying into Otolaryngology-Head and Neck Surgery.

OBJECTIVE: To create a longitudinal near-peer mentorship program for medical students applying to otolaryngology. METHODS: A program for longitudinal near-peer mentorship was designed based on a needs analysis of senior medical students. Program objectives were to (1) provide didactic education on common otolaryngology consults, (2) facilitate resident-student networking, and (3) enable applicants to meet other students. Senior otolaryngology residents were matched with medical students from across the United States applying to otolaryngology for a series of online small group meetings. Sessions included resident-designed didactics covering high-yield clinical scenarios and a mentorship component focused on transition to residency topics. Program evaluation included anonymized pre- and post-tests for each didactic session and an anonymous post-program participant survey. RESULTS: There were 40 student participants from across the United States, with an average attendance of 73% of sessions per participant. Performance on didactic testing improved for 2 of the 3 sessions. Participants stated they would be very likely to recommend each session to another student in the future (4.96/5.00, obs = 155). Participants stated the most valuable part of the program was interacting with residents (82% of responses), transition to residency advice (28%), and learning about otolaryngology consults (28%). Suggestions for improvement included expanding content, increasing the number of sessions, and involving additional faculty and residents. CONCLUSION: A longitudinal virtual experience can be valuable for near-peer mentorship for medical students applying to otolaryngology.

Prioritizing Diversity in Otolaryngology-Head and Neck Surgery: Starting a Conversation.

Academic centers embody the ideals of otolaryngology and are the specialty's port of entry. Building a diverse otolaryngology workforce-one that mirrors society-is critical. Otolaryngology continues to have an underrepresentation of racial and ethnic minorities. The specialty must therefore redouble efforts, becoming more purposeful in mentoring, recruiting, and retaining underrepresented minorities. Many programs have never had residents who are Black, Indigenous, or people of color. Improving narrow, leaky, or absent pipelines is a moral imperative, both to mitigate health care disparities and to help build a more just health care system. Diversity supports the tripartite mission of patient care, education, and research. This commentary explores diversity in otolaryngology with attention to the salient role of academic medical centers. Leadership matters deeply in such efforts, from culture to finances. Improving outreach, taking a holistic approach to resident selection, and improving mentorship and sponsorship complement advances in racial disparities to foster diversity.

The Epidemiological and Financial Effects of Pneumococcal Vaccination on Otitis Media Related Admissions in the United States.

OBJECTIVE: To quantify the prevalence of hospital admissions, the financial impact, and the trends in surgical procedure rates for AOM and CAOM for all ages before and after 13-valent pneumococcal conjugate vaccine (PCV13) introduction. METHODS: Retrospective analysis of the National Inpatient Sample (NIS) from 1998 to 2013 to determine the prevalence of AOM/CAOM related admissions and weighted frequencies of AOM/CAOM related International Classification of Diseases, ninth revision (ICD-9) hospital diagnoses. Prevalence of surgical procedures to treat CAOM, cost of admission, length of stay, and cost per day of admission were tabulated. Trend analysis of this data was performed. RESULTS: A total of 46 580 patients were hospitalized with AOM in the designated time period, of which 37 366 had CAOM. The prevalence of hospital admission due to AOM had the most pronounced decrease from pre-vaccine era (1998) to post-PCV13 implementation (2013) in age group 0 to 4 (32%) followed by age group 5 to 19 (7%). Age groups 20-64 and 65+ showed slight increases in prevalence. The trend in prevalence of admissions due to CAOM mirrors that of overall admissions with an 18% and 5.8% decrease in age groups 0-4 and 5-19, respectively, and a 1% increase in ages 20+. The inflation adjusted mean cost of admission did not significantly increase between 2001 and 2013. The total cost per admission was $4428 and $7546 for those with AOM and CAOM, respectively. Mastoidectomy rates increased by 17% in hospitalized children during the post-vaccine era but decreased in the elderly population. CONCLUSION: The prevalence of AOM/CAOM hospital admissions decreased from the pre-vaccine era (1998) to post-PCV13 implementation (2013) in pediatric patients. Surgical procedure utilization and cost of hospital admission for AOM/CAOM did not increase throughout the study period.

Age-Related Trends of Patients Undergoing Thyroidectomy: Analysis of US Inpatient Data from 2005 to 2013.

OBJECTIVES: As the country ages, thyroidectomies can be expected to be performed more frequently among the elderly. In this study, we stratified patients by age to explore demographics and complications of patients undergoing thyroidectomy. STUDY DESIGN: Retrospective study with a national database. SETTING: Nationwide Inpatient Sample. SUBJECTS AND METHODS: A total of 414,079 thyroidectomy cases from 2005 to 2013 were identified. Complications, outcomes, demographics, length of stay, and hospital charges were evaluated among patients and stratified by age into 4 cohorts: younger (<65 years), advanced age (65-74 years), elderly (75-84 years), and superelderly (≥85 years). RESULTS: Of 414,079 thyroidectomy cases identified, patients aged <65 years accounted for 75.6% of cases, while those aged 65-74, 75-84, and ≥85 years accounted for 16.3%, 7.2%, and 0.9%, respectively ( P < .001). There was a significant difference in length of stay, total hospital charges, and mortality throughout the different age groups ( P < .001), all trending upward with advancing age. In the aging population, incidence of recurrent laryngeal nerve injury, transfusion of erythrocytes, and acute cardiac complications increased with increasing age ( P < .001), while hypoparathyroidism decreased with age ≥65 but ≤85 years ( P < .001). Patients aged ≥75 years had increased odds of mortality as compared with their younger counterparts ( P < .001). CONCLUSION: This study utilized a national database to describe and elucidate trends in older populations undergoing thyroidectomy. Thyroid-related complications, including blood transfusion and recurrent laryngeal nerve injury, increased with increasing patient age. This information will help to guide pre- and postoperative care for aging patients undergoing thyroidectomy.

To Pack or Not to Pack: Inpatient Management of Epistaxis in the Elderly.

BACKGROUND: Epistaxis is common in elderly patients, occasionally necessitating hospitalization for the management of severe bleeds. In this study, we aim to explore the impact of nasal packing versus nonpacking interventions (cauterization, embolization, and ligation) on outcomes and complications of epistaxis hospitalization in the elderly. METHODS: The 2008-2013 National Inpatient Sample was queried for elderly patients (≥65 years) with a primary diagnosis of epistaxis and accompanying procedure codes for anterior and posterior nasal packing or nonpacking interventions. RESULTS: A total of 8449 cases met the inclusion criteria, with 62.4% receiving only nasal packing and 37.6% receiving nonpacking interventions. On average, nonpacking interventions were associated with a 9.9% increase in length of stay and a 54.0% increase in hospital charges. Comorbidity rates did not vary between cohorts, except for diabetes mellitus, which was less common in the nonpacking cohort (26.6% vs 29.0%; P = .014). Nonpacking interventions were associated with an increased rate of blood transfusion (24.5% vs. 21.8%; P = .004), but no significant differences in rates of stroke, blindness, aspiration pneumonia, infectious pneumonia, thromboembolism, urinary/renal complications, pulmonary complications, cardiac complications, or in-hospital mortality. Comparing patients receiving ligation or embolization, no differences in length of stay, complications, or in-hospital mortality were found; however, embolization patients incurred 232.1% greater hospital charges ( P < .001). CONCLUSION: Nonpacking interventions in the elderly do not appear to be associated with increased morbidity or mortality when compared to nasal packing only but appear to be associated with increased hospital charges and length of stay. Embolization in the elderly results in greater hospital charges but no change in outcome when compared to ligation.

Unruptured aneurysms in the elderly: perioperative outcomes and cost analysis of endovascular coiling and surgical clipping.

OBJECTIVE Observation and neurosurgical intervention for unruptured intracranial aneurysms (UIAs) in the elderly population is rapidly increasing. Cerebral aneurysm coiling (CACo) is favored over cerebral aneurysm clipping (CAC) in elderly patients, yet some elderly individuals still undergo CAC. The cost-effectiveness of treating UIAs requires further exploration. Understanding the effect of intervention on hospital charges and length of stay (LOS) as well as perioperative mortality and complications can further shed light on its economic impact. The purpose of this study was to analyze the cost and perioperative outcomes of UIAs in elderly patients (≥ 65 years of age) after CACo or CAC intervention. METHODS Retrospective cohorts of CACo and CAC admissions were extracted from National (Nationwide) Inpatient Sample data obtained between 2002 and 2013, forming parallel intervention groups to compare the following outcomes between elderly and nonelderly patients: average LOS and mean hospital admission costs, in-hospital mortality, and complications. Covariates included sex, race or ethnicity, and comorbidities. RESULTS Elderly patients undergoing CAC experienced an average LOS of 8.0 days, whereas elderly patients undergoing CACo stayed an average of 3.2 days. The mean hospital charges incurred during admission totaled $95,960 in the elderly patients who underwent CAC versus $87,960 in the ones who underwent CACo. Elderly patients in whom CAC was performed had a 2.2% rate of in-hospital mortality, with a 2.6 greater adjusted odds of in-hospital mortality than nonelderly patients treated with CAC. In contrast, elderly patients who underwent CACo had a 1.36 greater adjusted odds of in-hospital mortality than their nonelderly counterparts. Compared to nonelderly patients receiving both interventions, elderly individuals had a significantly higher prevalence of various comorbidities and incidence of complications. Elderly patients who received CAC experienced a 10.3% incidence rate of perioperative stroke, whereas their CACo counterparts experienced this complication at a rate of 3.5%. Elderly patients treated with CAC had greater odds of perioperative acute renal failure, whereas their CACo counterparts had greater odds of perioperative deep venous thrombosis and pulmonary embolism. CONCLUSIONS Intervention with CAC and CACo in the elderly is resource intensive and is associated with higher risk than in the nonelderly. Those deciding between intervention and conservative management should consider these risks and costs, especially the 2.2% postoperative mortality rate associated with CAC in the elderly population. Further comparative cost-effectiveness research is needed to weigh these costs and outcomes against those of conservative management.

Impact of obstructive sleep apnea in transsphenoidal pituitary surgery: An analysis of inpatient data.

OBJECTIVES/HYPOTHESIS: Although previous studies have reported increased perioperative complications among obstructive sleep apnea (OSA) patients undergoing any surgery requiring general anesthesia, there is a paucity of literature addressing the impact of OSA on postoperative transsphenoidal surgery (TSS) complications. The aim of this study was to analyze postoperative outcomes in transsphenoidal pituitary surgery patients with OSA. Secondarily, we examined patient characteristics and comorbidities. STUDY DESIGN: Retrospective analysis. METHODS: The 2002 to 2013 National Inpatient Sample was queried for patients undergoing TSS for pituitary neoplasm. Patients with an additional diagnosis of OSA were identified, and compared to a non-OSA cohort. RESULTS: There were 17,777 patients identified; 5.0% (N = 889) had an additional diagnosis of OSA. The OSA cohort had more comorbidities including diabetes mellitus, congestive heart failure, chronic pulmonary disease, coagulopathy, hypertension, hypothyroidism, liver disease, obesity, peripheral vascular disease, renal failure, acromegaly, and Cushing's syndrome. Postoperatively, OSA was independently associated with increased risks of tracheostomy (P = .015) and hypoxemia (P < .001), and decreased risk of cardiac complications (P = .034). OSA patients did not have increased rates of cerebrospinal fluid rhinorrhea, diabetes insipidus, reintubation, aspiration pneumonia, infectious pneumonia, thromboembolic complications, or urinary/renal complications. In-hospital mortality rates did not vary between the two cohorts. CONCLUSIONS: In patients who underwent transsphenoidal pituitary surgery, OSA was associated with higher rates of certain pulmonary and airway complications. OSA was not associated with increased non-pulmonary/airway complications or inpatient mortality, despite older average age and higher comorbidity rates. LEVEL OF EVIDENCE: 2C. Laryngoscope, 128:1027-1032, 2018.

Impact of liver disease on outcomes of patients hospitalized for epistaxis.

OBJECTIVES: Liver disease (LD) often results in coagulation abnormalities that may predispose to more severe epistaxis. The purpose of this analysis was to examine characteristics of patients hospitalized for epistaxis with LD and explore the impact of LD on patient outcomes. METHODS: The 2002 to 2013 National Inpatient Sample was queried for cases with a primary diagnosis of epistaxis. Cases with additional codes meeting the Agency for Healthcare Research and Quality's definition of LD were identified and compared to the non-LD cohort. RESULTS: Out of 39,879 cases meeting inclusion criteria, 3.6% had LD. LD was associated with younger age (55.7 years vs. 67.5 years; P < 0.001), longer hospital stay (3.9 days vs. 3.2 days; P < 0.001), and greater hospital charges ($26,141 vs. $18,200; P < 0.001) compared to the non-LD cohort. LD patients had higher rates of alcohol abuse, coagulopathy, chronic blood loss anemia, and renal failure. LD patients also had higher rates of sepsis, urinary/renal complications, respiratory failure, and infectious pneumonia. LD was associated with decreased rates of aggressive management (defined as ligation or embolization) (6.6%-9.0%; P < 0.002) and anterior or posterior nasal packing. In our multivariate logistic regression model correcting for age, gender, race, and significant comorbidities, LD was associated with 1.520 (1.336-1.729; P < 0.001) greater odds of transfusion and 2.264 (1.372-3.736; P = 0.001) greater odds of in-hospital mortality. CONCLUSION: Among patients hospitalized for epistaxis, LD resulted in greater morbidity and mortality. Clinicians should be aware of the particular risk that LD bears on the hospitalized epistaxis patient. LEVEL OF EVIDENCE: 2C. Laryngoscope, 127:2691-2697, 2017.

Shared Canadian Curriculum in Family Medicine (SHARC-FM): Creating a national consensus on relevant and practical training for medical students.

PROBLEM ADDRESSED: In 2006, leaders of undergraduate family medicine education programs faced a series of increasing curriculum mandates in the context of limited time and financial resources. Additionally, it became apparent that a hidden curriculum against family medicine as a career choice was active in medical schools. OBJECTIVE OF PROGRAM: The Shared Canadian Curriculum in Family Medicine was developed by the Canadian Undergraduate Family Medicine Education Directors and supported by the College of Family Physicians of Canada as a national collaborative project to support medical student training in family medicine clerkship. Its key objective is to enable education leaders to meet their educational mandates, while at the same time countering the hidden curriculum and providing a route to scholarship. PROGRAM DESCRIPTION: The Shared Canadian Curriculum in Family Medicine is an open-access, shared, national curriculum (www.sharcfm.ca). It contains 23 core clinical topics (determined through a modified Delphi process) with demonstrable objectives for each. It also includes low- and medium-fidelity virtual patient cases, point-of-care learning resources (clinical cards), and assessment tools, all aligned with the core topics. French translation of the resources is ongoing. CONCLUSION: The core topics, objectives, and educational resources have been adopted by medical schools across Canada, according to their needs. The lessons learned from mounting this multi-institutional collaborative project will help others develop their own collaborative curricula.

In-Hospital Mortality and Post-Transplantation Complications in Elderly Multiple Myeloma Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation: A Population-Based Study.

Autologous hematopoietic stem cell transplantation (auto-HSCT) has improved survival in patients with multiple myeloma (MM) and is increasingly used in elderly patients. The aim of this study was to characterize and compare in-hospital complications and mortality after auto-HSCT in younger (< age 65) versus elderly (> age 65) MM patients utilizing the Nationwide Inpatient Sample. Over a 3-year period (2008 to 2010), 2209 patients with MM were admitted to US hospitals for auto-HSCT. The median age was 59 years, with 1650 patients (74.7%) younger than age 65 and 559 patients (25.3%) 65 or older. Overall, in-hospital mortality in MM patients after auto-HSCT was rare (1.5%) and there was no significant difference in mortality between elderly and younger patients. Elderly patients did have a significantly increased mean length of stay (18.6 days + 10.8 days [SD] versus 16.8 days + 7.2 days [SD], P < .001) and mean total hospital charges ($161,117 + $105,008 [SD] versus $151,192 + $78,342 [SD] , P = .018) compared with younger patients. Elderly patients were significantly more likely than younger patients to develop major in-hospital post-transplantation complications such as severe sepsis (odds ratio [OR], 2.70; 95% confidence interval [CI], 1.40 to 5.21; P = .003), septic shock (OR, 3.10; 95% CI, 1.43 to 6.71; P = .004), pneumonia (OR, 1.62; 95% CI, 1.06 to 2.46; P = .024), acute respiratory failure (OR, 3.44; 95% CI, 1.70 to 6.96; P = .001), endotracheal intubation requiring prolonged mechanical ventilation (OR, 2.19; 95% CI, 1.06 to 4.55; P = .035), acute renal failure (OR, 2.14; 95% CI, 1.38 to 3.33; P = .001), and cardiac arrhythmias (OR, 2.06; 95% CI, 1.52 to 2.79; P <.001). These data may help guide informed consent discussions and provide a focus for future studies to reduce treatment-related morbidity in elderly MM patients undergoing auto-HSCT.

Outcomes of Vestibular Schwannoma Surgery among the Elderly.

Objective To compare comorbidities and in-hospital complications between elderly and nonelderly patients undergoing vestibular schwannoma (VS) surgery. To examine average length of stay (LOS) and hospital charges among elderly patients. Study Design Population-based inpatient registry analysis. Setting Academic medical center. Subjects and Methods Retrospective analysis of the National Inpatient Sample for patients undergoing VS surgery from 2002 to 2010: 4137 patients met inclusion criteria, with 519 (12.5%) in the elderly cohort (≥65 years). Outcomes of elderly and nonelderly (<65 years) patient cohorts were compared. Results Compared with the nonelderly cohort, the elderly cohort had more comorbidities, including diabetes mellitus, hypertension, and pulmonary disease (all P < .001). Elderly patients had longer LOS (6.5 vs 5.4 days; P = .001) but did not incur significantly greater hospital charges. Rates of cerebrospinal fluid leak, meningitis, and facial nerve injury did not vary significantly between groups. The elderly cohort experienced higher rates of in-hospital complications, including acute cardiac events, iatrogenic cerebrovascular infarction/hemorrhage, postoperative bleeding (hemorrhage/hematoma), and in-hospital mortality (all P < .05). In binary logistic regression, correcting for patient demographics and presence of comorbidities, elderly status was associated with 1.848 (95% confidence interval, 1.167-2.927; P = .009) greater odds of medical complications and 13.188 (95% confidence interval, 1.829-95.113; P = .011) greater odds of in-hospital mortality. Conclusion Elderly patients undergoing VS surgery have more comorbidities, in-hospital complications, and longer LOS than nonelderly patients. The elderly cohort had a greater rate of in-hospital mortality, though rare. Interestingly, elderly patients did not have a higher rate of many known complications associated with VS surgery and did not incur more hospital charges.

Arterial ligation versus embolization in epistaxis management: Counterintuitive national trends.

OBJECTIVES/HYPOTHESIS: Arterial ligation and embolization are treatment modalities indicated in severe and refractory epistaxis. The purpose of this study was to examine temporal trends and compare outcomes in treatment of hospitalized epistaxis patients with ligation or embolization. METHODS: This retrospective cohort analysis utilized the 2008 to 2013 National Inpatient Sample to identify patients admitted with a primary diagnosis of epistaxis, and an associated procedure code for ligation or embolization. RESULTS: A total of 1,813 cases met the inclusion criteria, with 57.1% undergoing ligation. During the study period, treatment with ligation has trended downward, whereas treatment with embolization has remained constant. Overall, ligated patients were older (64.1 vs. 62.4 years; P = 0.027) and had higher rates of congestive heart failure (15.1% vs. 9.8%; P = 0.001). No significant differences in rates of chronic pulmonary disease, coagulopathy, liver disease, or hereditary hemorrhagic telangiectasia were observed between cohorts. No differences were observed in rates of blood transfusion, stroke, blindness, or in-hospital mortality; however, ligated patients had lower rates of intubation/tracheostomy (2.8% vs. 5.3%; P = 0.009). Ligated patients also experienced shorter hospital stays (3.6 vs. 4.0 days; P = 0.014) and incurred lower hospital charges ($33,029 vs. $69,304; P < 0.001). CONCLUSION: Compared to embolization, ligation is associated with significantly decreased hospital charges and shorter hospital stay, without an increase in complication rates. Counterintuitively, ligation appears to be trending downward nationally in its use relative to embolization. LEVEL OF EVIDENCE: 2C Laryngoscope, 127:1017-1020, 2017.

Malignant otitis externa hospitalizations: Analysis of patient characteristics.

OBJECTIVES/HYPOTHESIS: Malignant otitis externa (MOE) is a rare disorder that is not well studied in the inpatient setting. The Nationwide Inpatient Sample (NIS) database was utilized to analyze characteristics and predischarge outcomes of hospitalized MOE patients. METHODS: MOE hospitalizations were identified in the 2002 to 2013 NIS. Patient demographics, length of hospital stay, hospital charges, concomitant diagnoses, treatment-related procedures, complications, and in-hospital mortality rates were examined, with comparisons made among age cohorts and between diabetes mellitus (DM) and non-DM groups. RESULTS: A total of 8,300 cases of inpatient MOE were identified, with elderly DM patients compromising 22.7% of cases. Compared to adults, elderly patients had more inpatient procedures, longer hospitalizations (6.0 vs. 4.3 days), higher hospital charges ($26,712 vs. $19,047) (all P < 0.001), greater odds of in-hospital complications, and in-hospital mortality (odds ratio 14.435, 95% confidence interval 5.313-39.220). Adult/elderly patients with DM had more comorbidities, longer hospital stays (5.5 vs. 4.0 days), and higher hospital charges ($25,118 vs. $17,039) (all P < 0.001) than non-DM patients. However, DM was not associated with greater in-hospital mortality rates (0.6% vs. 0.5%; P = 0.640). Compared to the adult/elderly cohort, pediatric patients had higher rates of nonelective admissions (19.8% vs. 14.5%), shorter hospital stays (2.9 vs. 4.9 days), and lower hospital charges ($8,876 vs. $21,672) (all P < 0.05). CONCLUSION: Elderly diabetic patients made up a smaller fraction of hospitalized MOE cases than anticipated. Elderly patients had greater in-hospital complications and mortality. Diabetes mellitus in adult/elderly patients was not associated with increased mortality. Pediatric patients fared well with low complications rates and no instances of in-hospital mortality. LEVEL OF EVIDENCE: 2C. Laryngoscope, 127:2328-2336, 2017.

Impact of chronic obstructive pulmonary disease on patients undergoing laryngectomy for laryngeal cancer.

OBJECTIVES/HYPOTHESIS: Although chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients undergoing laryngeal cancer surgery, the impact of this comorbidity in this setting is not well established. In this analysis, we used the Nationwide Inpatient Sample (NIS) to elucidate the impact of COPD on outcomes after laryngectomy for laryngeal cancer. METHODS: The NIS was queried for patients admitted from 1998 to 2010 with laryngeal cancer who underwent total or partial laryngectomy. Patient demographics, type of admission, length of stay, hospital charges, and concomitant diagnoses were analyzed. RESULTS: Our inclusion criteria yielded a cohort of 40,441 patients: 3,051 with COPD and 37,390 without. On average, COPD was associated with an additional $12,500 (P < 0.001) in hospital charges and an additional 1.4 days (P < 0.001) of hospital stay. There was no significant difference in incidence of in-hospital mortality between the COPD and non-COPD groups after total laryngectomy (1.1% in COPD vs. 1.0% in non-COPD; P = 0.776); however, there was an increased incidence of in-hospital mortality in the COPD group compared to the non-COPD group after partial laryngectomy (3.4% in COPD vs. 0.4% in non-COPD; P < 0.001). Multivariate adjusted logistic regression revealed that COPD was associated with greater odds of pulmonary complications after both partial laryngectomy (odds ratio [OR] = 3.198; P < 0.001) and total laryngectomy (OR = 1.575; P < 0.001). CONCLUSION: Chronic obstructive pulmonary disease appears to be associated with greater hospital charges, length of stay, and postoperative pulmonary complications in patients undergoing laryngectomy for laryngeal cancer. Chronic obstructive pulmonary disease after partial, but not total, laryngectomy appears to be associated with increased risk of in-hospital mortality. LEVEL OF EVIDENCE: 2C. Laryngoscope, 2016 127:417-423, 2017.