The PAC (Post-operative Airway Compromise) score - First steps to Develop a Post-Surgery Tool for the Assessment of Upper Airway-related Complications following Anterior Cervical Spine Surgery.

BACKGROUND: Acute upper airway compromise is a rare but catastrophic complication after anterior cervical discectomy and fusion (ACDF). This study aims to develop a score to identify patients at risk for acute postoperative airway compromise (PAC). METHODS: Potential risk factors for acute PAC were selected by a modified Delphi process. Ten patients with acute PAC were identified out of 1,466 patients who underwent elective ACDF between July 2014 - May 2019. A comparison group was created by a randomized selection process (non-PAC group). Associated factors with PAC and a p-value <.10 were entered into a logistic regression model and coefficients contributed each risk factor's overall score. Calibration of the model was evaluated by Hosmer-Lemeshow (H-L) goodness-of-fit test. Quantitative discrimination was calculated and the final model was internally validated with bootstrap sampling. RESULTS: We identified 18 potential risk factors from our Delphi process, of which 6 factors demonstrated a significant association with airway compromise: age >65 years, current smoking status, ASA >2, history of a bleeding disorder, surgery of upper subaxial cervical spine (>C4), and duration of surgery >179 min. The final prediction model included five predictors with very strong performance characteristics. These five factors formed the PAC-Score (PACS) which had a range from 0 to 100. A score of 20 yielded the greatest balance of sensitivity (80%) and specificity (88%). CONCLUSIONS: The acute Postoperative Airway Compromise Score (PACS) demonstrates strong performance characteristics. The PAC score may help identify patients at risk for upper airway compromise caused by surgical site abnormalities.

Ceruminous adenocarcinoma: An analysis of the Surveillance Epidemiology and End Results (SEER) database.

OBJECTIVES: Ceruminous adenocarcinoma is a rare malignancy. However, due to the paucity of cases, this has been difficult to study. Using a population-based national database, patient demographics and survival trends were analyzed to further elucidate the management of this malignancy. METHODS: The SEER database was queried for patients diagnosed with ceruminous adenocarcinoma between 1973 and 2010. RESULTS: Twenty-two patients were identified in the database. The average age of diagnosis was between 60 and 64 years. All of the patients underwent surgical resection of the primary malignancy. Eight patients (36%) also had postoperative radiation. CONCLUSIONS: Ceruminous adenocarcinoma is uncommon but may not have as poor a prognosis as previously thought. Surgical resection alone appears to be a reasonable treatment option. Larger prospective studies are needed, but database analysis like this may provide clarity on the management of uncommon diseases.

Effect of a second primary thyroid carcinoma on patients with head and neck squamous cell carcinoma.

BACKGROUND: The purpose of this study was to characterize the timing, histology, and behavior of second primary thyroid carcinoma (SPTC) developing after a diagnosis of head and neck squamous cell carcinoma (HNSCC). METHODS: We conducted a retrospective review of the Surveillance, Epidemiology, and End Results (SEER) 9 database. RESULTS: Patients with HNSCC who develop SPTC die 1.6 times sooner than those without SPTC. This effect is only seen if SPTC presents >6 months after diagnosis of HNSCC. Models were adjusted for age, sex, year of diagnosis, and location of HNSCC. There was no effect of prior radiation therapy on either mortality rates or time to development of thyroid cancer in patients with SPTC. The type of thyroid carcinoma that developed was similar between cohorts. CONCLUSION: The development of SPTC in patients with HNSCC results in decreased overall length of survival. © 2015 Wiley Periodicals, Inc. Head Neck 38: E890-E894, 2016.

Social networking and professionalism in otolaryngology residency applicants.

OBJECTIVES/HYPOTHESIS: To assess compliance with Accreditation Council for Graduation Medical Education standards of professionalism among otolaryngology residency applicants with publicly searchable Facebook profiles. STUDY DESIGN: Case series. METHODS: Applicants to an otolaryngology residency program were searched on the Facebook website. Multiple matches were narrowed by available information until the correct individual was identified. Searches were performed in a manner that would not allow access to restricted information, thus showing only what would be accessible publicly. Four reviewers evaluated all profiles and generated a professionalism score. Scores were collated with National Resident Matching Program data and match results to identify significant associations. RESULTS: Of the 234 applicants to our institution, 119 had Facebook profiles. Of these, 85 profiles contained information beyond simple demographics. Eleven percent of applicant profiles contained pictures or text that at least one reviewer felt could be perceived as unprofessional. There were six profiles with content considered to be concerning and one profile that contained clear violations of professional boundaries. Professionalism score did not correlate with whether the applicant matched, was interviewed, or received a place on the rank list. Age, gender, marital status, and Step 1 score did not correlate with a lower professionalism score. Our series included 61% of all otolaryngology applicants. CONCLUSIONS: Publicly available Facebook profiles with questionable content existed for 11% of otolaryngology applicants in this series. This finding did not affect applicants' match outcomes, nor was it predicted by any data available on the applicants' applications.

Outcomes of intubation in difficult airways due to head and neck pathology.

The purpose of this study was to examine the impact of surgical pathology, anesthesiologist experience, and airway technique on surgically relevant outcomes in patients identified by preoperative laryngoscopy to have a difficult airway due to head and neck pathology. We prospectively recorded a series of 152 difficult airway cases due to head and neck pathology out of 2,145 direct laryngoscopies undertaken between November 2005 and June 2008. One of two senior anesthesiologists specializing in head and neck procedures intubated 101 (66.4%) of the 152 patients and did so 3.3 minutes faster (p = 0.51), with better oxygenation (87.3 vs. 81.8%; p = 0.02) and fewer airway plan changes (p = 0.001) than did other, nonspecialist anesthesiologists. Predictors of failure of the first intubation plan included: cancer diagnosis (p = 0.02), previous radiotherapy (p = 0.03), and supraglottic lesions (p = 0.03). Glottic/subglottic lesions required the most intubation attempts (p = 0.02). Awake fiberoptic intubation was the most common method used (44.7%) but resulted in a change in the airway plan in 6 cases (8.8%). Gas induction maintained the best oxygenation (p = 0.01). Awake tracheostomy was infrequent (1.3%) and took the longest (p = 0.006). We concluded that difficult airways due to head and neck pathology require teamwork and a backup plan. An anesthesiologist specializing in head and neck procedures may help to avoid adverse outcomes associated with cancer, especially previously irradiated supraglottic/glottic lesions, leading to a less frequent need for awake tracheostomy.

Incidence and outcomes of stricture formation postlaryngectomy.

OBJECTIVE: Postlaryngectomy stricture formation and dysphagia negatively affect quality of life and result in nutritional compromise. Understanding risk factors and successful treatment strategies may improve treatment outcomes. STUDY DESIGN: Historical cohort study. SETTING: Tertiary care medical center. SUBJECTS AND METHODS: Patients at a tertiary care center who underwent a total laryngectomy between 2003 and 2009 (N = 263) were evaluated in a retrospective manner. Patient demographics, comorbidities, tobacco and alcohol usage, dietary outcomes, feeding tube dependence, and treatment modalities were assessed. Management strategies and outcomes were evaluated. RESULTS: Strictures developed in 19% (n = 49) of patients, and the majority (82%) occurred in the first year. Incidences of stricture formation were similar for primary (19%) and salvage laryngectomy (19%) patients. Patients undergoing salvage laryngectomy were 2 times more likely to be reconstructed with a free flap, whereas those undergoing a primary laryngectomy were 3 times more likely to be closed primarily. Tubed flap reconstruction significantly increased the incidence of stricture formation compared to primary closure (P = .02) in salvage laryngectomy cases. In primary laryngectomy patients, stricture formation did not correlate with flap reconstruction (P = .34) or adjuvant radiation therapy (P = .79). Patients who required a single dilation had better dietary outcomes compared to patients who required serial dilations (P = .14). There was no difference in overall disease-free survival in primary vs salvage laryngectomy patients (P = .95). CONCLUSION: Rates of stricture formation were the same in patients undergoing salvage compared to primary total laryngectomy.