Positive Margin Rates in Oral Cavity and Oropharyngeal Malignancies: A National Analysis.

Objective: Oral cavity malignancies (OCC) and oropharyngeal malignancies (OPC) historically have higher rates of positive surgical margins (PSM) compared to other solid malignancies. The objective of this study is to understand trends and predictors in positive surgical margins (PSM) for OPSCC and OCSCC using the National Cancer Database (NCDB).

Study Design: Retrospective Cohort Study.

Clarifying the Diagnosis and Management of Acute Uncomplicated Pediatric Mastoiditis.

Introduction: Acute pediatric mastoiditis is a bacterial infection of the mastoid bone most commonly associated with acute otitis media. Complicated mastoiditis is traditionally characterized by intracranial complications or subperiosteal abscess, but definitions are inconsistent in the literature. Surgical intervention is identified as the main treatment for complicated mastoiditis, but there is some evidence to support medical management of uncomplicated mastoiditis.

Thyroid Cancer Incidence and Tumor Size in New Mexico American Indians, Hispanics, and Non-Hispanic Whites, 1992 to 2019.

Background: The incidence of thyroid cancer in the United States has risen dramatically since the 1970s, driven by an increase in the diagnosis of small tumors. There is a paucity of published New Mexico (NM) specific data regarding thyroid cancer. We hypothesized that due to New Mexico's unique geographic and cultural makeup, the incidence of thyroid cancer and tumor size at diagnosis in this state would differ from that demonstrated on a national level.

Implementing a formal curriculum on surgical ethics and palliative care for otolaryngology residents.

Objective: Residents are faced with ethical issues every day but most residency curriculums do not routinely include formal ethics skills training. In order to address this, a comprehensive curriculum on ethics and surgical palliative care was implemented for otolaryngology residents.

Methods: An 8-h ethics didactics curriculum was designed in collaboration with our institution's Institute of Ethics.

Predicting nodal metastases in squamous cell carcinoma of the oral tongue using artificial intelligence.

Objective: The presence of occult nodal metastases in patients with squamous cell carcinoma (SCC) of the oral tongue has implications for treatment. Upwards of 30% of patients will have occult nodal metastases, yet a significant number of patients undergo unnecessary neck dissection to confirm nodal status. This study sought to predict the presence of nodal metastases in patients with SCC of the oral tongue using a convolutional neural network (CNN) that analyzed visual histopathology from the primary tumor alone.

Drug Shortages and Otolaryngology.

Every year in the United States, hundreds of shortages of life-saving, essential drugs impact patients and health care workers. While otolaryngologists may be shielded from these relative to other specialties, there is still a significant clinical impact with potentially dangerous consequences. Shortages of local anesthetics lead to increased costs, labor demands, and risk of medical errors.

Laryngeal Trauma.

Laryngeal trauma is rare but potentially fatal. Initial evaluation includes efficient history and physical examination, imaging, bedside flexible laryngoscopy, and if necessary, operative endoscopic evaluation. Multiple classification systems exist for laryngeal trauma, and each has its merits.

Frailty as a Predictor of Post-Surgical Outcomes in Patients With Cutaneous Malignancies of the Scalp and Neck Requiring Flap Reconstruction.

Background: Investigate the ability of frailty status to predict post-surgical outcomes in patients with cutaneous malignancies of the scalp and neck undergoing flap reconstruction.

Methods: National Surgical Quality Improvement Program database was used to isolate patients with cutaneous malignancies of the scalp and neck who underwent surgical resection between 2015 to 2019. Univariate and multivariate analyses were performed to determine if frailty score correlated with negative post-operative outcomes.

Lymph Node Metastases in Papillary Thyroid Carcinoma can be Predicted by a Convolutional Neural Network: a Multi-Institution Study.

Objectives: The presence of nodal metastases in patients with papillary thyroid carcinoma (PTC) has both staging and treatment implications. However, lymph nodes are often not removed during thyroidectomy. Prior work has demonstrated the capability of artificial intelligence (AI) to predict the presence of nodal metastases in PTC based on the primary tumor histopathology alone.

Ibuprofen prescription following adult tonsillectomy reduces postoperative opioid use.

Background: Based on a 2018 American Academy of Otolaryngology - Head and Neck Surgery survey, an average of 37 tablets of opioid medication, or about a week's worth of medication, were prescribed after adult tonsillectomy. Nearly 15% of patients will still be taking opioids one year after an initial weeklong prescription, according to data from the Centers for Disease Control and Prevention. Non-steroidal anti-inflammatory medications have traditionally been avoided in adult tonsillectomy patients due to concern for increased bleeding risk from platelet dysfunction, despite little evidence supporting this claim.

Holding Curative and Palliative Intentions.

When a patient is diagnosed with an advanced head and neck cancer, a decision about whether to have surgery can dominate what remains of that patient's life: prospective benefits can be limited, and complication risks can be high. Realizing dual curative and palliative intention with a single operation can be a reasonable surgical oncological care goal. In such cases, differentiating between the curative and palliative potential of surgery is key to developing dual intentional clarity.

Post-Procedural Opioid Prescribing in Children: A Survey of the American Academy of Pediatrics.

Introduction: North America is in the midst of an opioid epidemic. The role of pediatric surgeons and other procedural specialists in this public health crisis remains unclear. There is likely considerable variation in the use of opioid and non-opioid analgesics, but the spectrum of practice is still uncertain.

Predicting nodal metastases in papillary thyroid carcinoma using artificial intelligence.

Background: The presence of nodal metastases is important in the treatment of papillary thyroid carcinoma (PTC). We present our experience using a convolutional neural network (CNN) to predict the presence of nodal metastases in a series of PTC patients using visual histopathology from the primary tumor alone.

Methods: 174 cases of PTC were evaluated for the presence or absence of lymph metastases.

Evaluation of Antibiotic Prophylaxis for Acute Nonoperative Orbital Fractures.

Purpose: The use of antibiotic prophylaxis for the prevention of infection in nonoperative orbital fractures is controversial, with limited high-quality evidence and inconsistent recommendations in the current scientific literature. Our primary study objective was to identify the prophylactic antibiotic prescribing pattern at our institution for nonoperative orbital fractures and to determine the effect of antibiotic prophylaxis.

Methods: We retrospectively reviewed 16 years of data from a single institution on patients with acute traumatic fractures of the orbital floor or medial orbital wall.

One-year patient survival correlates with surgeon volume after elective open abdominal aortic surgery.

Objective: Volume-outcome relationships in surgery have been well established. Studies have shown that high-volume surgeons provide improved outcomes in performing open abdominal aneurysm repairs. The hypothesis of this study was that high-volume surgeons provide superior short-term and midterm outcomes of elective open aortic operations compared with low-volume surgeons.

Increasing surgeon volume correlates with patient survival following open abdominal aortic aneurysm repair.

Objective: The annual number of open abdominal aortic aneurysm (AAA) repairs has decreased dramatically over the last decade, making the search for physician case volume thresholds more important. The purpose of this study was to identify a minimum threshold for annual surgeon case volume in open AAA repair.

Methods: The New York Statewide Planning and Research Cooperative System inpatient database was used to identify all patients undergoing open repair of an intact AAA between 2000 and 2008.

Aortic Anatomic Severity Grade Correlates with Midterm Mortality in Patients Undergoing Abdominal Aortic Aneurysm Repair.

Background: Anatomic severity grade (ASG) can be used to assess abdominal aortic aneurysm (AAA) anatomic complexity. High ASG is associated with complications following endovascular repair of AAAs and we have demonstrated that ASG correlates with resource utilization. The hypothesis of this study is that ASG is directly related to midterm mortality in patients undergoing AAA repair.

Prevalence and Perceptions of Team Training Programs for Pediatric Surgeons and Anesthesiologists.

Background: Team training programs adapt crew resource management principles from aviation to foster communication and prevent medical errors. Although multiple studies have demonstrated that team training programs such as TeamSTEPPS improve patient outcomes and safety across medical disciplines, limited data exist about their application to pediatric surgical teams. The purpose of this study was to investigate usage and perceptions of team training programs by pediatric surgeons and anesthesiologists.

Superior 3-Year Value of Open and Endovascular Repair of Abdominal Aortic Aneurysm with High-Volume Providers.

Background: Conflicting literature exists regarding resource utilization for cardiovascular care when stratified by provider volume. This study investigates the differences in value of abdominal aortic aneurysm (AAA) repair by high- and low-volume providers. The hypothesis of this study is that high-volume providers will provide superior value AAA repairs when compared to low-volume providers.