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Background: Alcohol‐based skin preparations were first approved for surgical use in 1998 and have since become standard in most surgical fields. The purpose of this report is to examine incidence of surgical fires because of alcohol‐based skin preparation and to understand how approval and regulation of alcohol‐based skin preparations impacted trends in fires over time. Methods: We identified all reported surgical fires resulting in patient or staff harm from 1991 through 2020 reported to the Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database. We examined incidence of fires because of these preparations, trends after approval and regulation, and common causes. Results: We identified 674 reports of surgical fires resulting in harm to patients and surgical personnel, in which 84 involved an alcohol‐based preparation. The time‐adjusted model shows that from 1996 through 2006, there was a 26.4% increase in fires followed by a 9.7% decrease from 2007 to 2020. The decrease in fires was most rapid for head and neck and upper aerodigestive tract surgeries. Qualitative content analysis revealed improper surgical site preparation as well as close proximity of surgical sites to an oxygen source as the most common causes of fires. Conclusion: Since FDA approval, alcohol‐based preparation solutions have been associated with a significant percentage of surgical fires. Warning label updates from 2006 to 2012 coupled with increased awareness efforts of associated risks of alcohol‐based surgical solutions likely contributed to the decrease in fires. Improper surgical site preparation technique and close proximity of surgical sites to oxygen continue to be risk factors for fires. Level of Evidence: 4 Laryngoscope, 134:607–613, 2024 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To evaluate the incidence of head and neck cancers (HNC) in high‐risk current and/or former smokers with screening low‐dose computed tomography (LDCT) chest versus chest x‐ray (CXR). Study Design: Second analysis of randomized clinical trial. Methods: We performed a secondary analysis examining the incidence of HNC in the National Lung Screening Trial. This was a randomized trial comparing LDCT versus CXR screening for lung cancer detection in high‐risk individuals (30 pack‐year smokers who currently smoke or quit within the last 15 years, aged 55–74). We compared the incidence of HNC in participants screened with LDCT versus CXR. We performed subgroup analyses in participants with mucosal HNC (oral cavity, oropharynx, larynx, hypopharynx, nasal/sinus cavity, or nasopharynx) or nonmucosal HNC (thyroid or salivary gland) and examined survival in the two screening arms. Results: This trial enrolled 53,452 participants with a median follow‐up of 6.2 years after randomization. The incidence of HNC was 111.8 cases per 100,000 person‐years in the LDCT group versus 87.1 cases per 100,000 person‐years in the CXR group (rate ratio 1.30, 95% confidence interval [CI] 1.05–1.61). There were 11.7 deaths from HNC per 100,000 person‐years in the LDCT group and 12.9 deaths per 100,000 person‐years in the CXR group (hazard ratio 0.80, 95% CI 0.42–1.52). Conclusions: Participants screened with LDCT had a modestly higher incidence of HNC. As uptake and adherence of lung cancer screening guidelines improve, clinicians should recognize that incidental findings from screening may lead to increased detection of HNC. Level of Evidence: 3 Laryngoscope, 132:1609–1614, 2022 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To assess the causative factors that contribute to racial disparities in head and neck squamous cell carcinoma (HNSCC) and establish the role of hospital factors in racial disparities. Study Design: Retrospective database analysis. Methods: Patients with surgically treated HNSCC were identified using the National Cancer Database (2004–2014). Logistic and proportional‐hazard regression models were used to characterize the factors that contribute to racial disparities. Differences in quality of care received were compared among black and white patients using previously validated metrics. Results: We identified 69,186 eligible patients. Black patients had a 48% higher mortality than white patients (HR 1.48; 95% confidence interval [CI], 1.41–1.54). Black patients had a lower mean quality score (67.6%; 95% CI, 66.8%–69.4%) compared with white patients (71.2%: 95% CI, 71.0%–71.4%) for five quality metrics. After adjusting for differences in patient, oncologic, and hospital factors we were able to explain 60% of the excess mortality for black patients. Oncologic factors at presentation accounted for 57.7% of observed mortality differences, whereas hospital characteristics and quality of care accounted for 11.5%. After adjusting for these factors, black patients still had a 19% higher mortality (HR 1.19; 95% CI, 1.14–1.24). Conclusions: Oncologic factors at presentation are a major contributor to racial disparities in outcomes for HNSCC. Hospital factors, such as quality, volume, and safety‐net status, constitute a minor factor in the mortality difference. Resolving existing disparities will require detecting head and neck cancer at an earlier stage and improving the quality of care for black patients. Level of Evidence: 3. Laryngoscope, 131:1053–1059, 2021 [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To investigate patterns of tracheostomy-associated death in the United States.Study Design: Retrospective database review.Methods: We used Multiple Cause-of-Death data from the Centers for Disease Control and Prevention to determine cumulative national mortality associated with tracheostomy complications in the United States from 2007 to 2016. Using International Classification of Diseases, Tenth Revision data, we investigated how frequently tracheostomy-related complications were reported in cause of death data. We then compared the characteristics of patients with tracheostomy-related mortality to patients reported to have died of other causes.Results: Over the 10-year period studied, we identified 623 tracheostomy-related deaths (537 adults and 86 children) out of 25,587,306 total deaths reported. Although absolute mortality was higher in adults, the reported base rate of tracheostomy complication-associated mortality was tenfold higher in children. Most tracheostomy-related deaths occurred in a hospital facility (74.5% in adults). Deaths associated with tracheostomy complications were significantly more common for African American children (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.26-3.24) and adults (OR: 1.59, 95% CI: 1.29-1.96) or in Hispanic adults (OR: 1.42, 95% CI: 1.06-1.89). Deaths related to a tracheostomy complication more commonly occurred on the weekend (OR: 1.24, 95% CI: 1.04-1.49) and in the most recent 2-year period (OR: 1.31, 95% CI: 1.03-1.68). Adults with a bachelor's, master's or doctorate degree were significantly less likely to have mortality associated with a tracheostomy-related complication (OR: 0.54, 95% CI: 0.39-0.75).Conclusions: Tracheostomy-related complications were implicated in the deaths of a significant number of individuals. Several demographic groups had increased likelihood of tracheostomy-related mortality. Future research is necessary to develop targeted interventions to decrease harm.Level Of Evidence: NA Laryngoscope, 129:619-626, 2019. [ABSTRACT FROM AUTHOR]

Objectives: Sentinel lymph node biopsy (SLNB) has been shown to be an accurate technique for staging the neck in early-stage oral cavity squamous cell carcinoma (OCSCC) and has been incorporated in treatment guidelines as an option instead of elective neck dissection (END). However, utilization of SLNB in the United States remains unclear, and existing prospective studies did not directly compare survival between SLNB and END.Methods: We conducted a retrospective cohort study of patients with stage I to II OCSCC (cT1-2cN0cM0) who underwent staging of the neck in the National Cancer Data Base from 2012 to 2015. We compared the practice patterns and outcomes of patients who underwent SLNB versus END.Results: We identified 8,328 eligible patients with a median follow-up of 35.4 months. SLNB was used for 240 patients, or 2.9% of stage I to II OCSCC. Completion neck dissection was avoided in 63.8% of patients undergoing SLNB. SLNB was associated with reduced perioperative morbidity, with median length of hospital stay of 1.0 days versus 3.0 days after END (P < 0.001). Perioperative 30-day mortality was 0% after SLNB versus 0.7% after END (P = 0.42). Overall 3-year survival was 82.0% after SLNB and 77.5% after END (P = 0.40). After adjustment, overall survival was equivalent between patients who underwent SLNB versus END (adjusted hazard ratio 1.03, confidence interval 0.67-1.59).Conclusions: SLNB for stage I to II OCSCC is associated with reduced length of hospital stay and equivalent overall survival compared with END. Despite these attributes, SLNB remains rarely used in the United States.Level Of Evidence: NA Laryngoscope, 129:162-169, 2019. [ABSTRACT FROM AUTHOR]

Objective: For the first time in 30 years, the eighth edition of the American Joint Committee on Cancer (AJCC) Staging Manual offers major changes in the staging of oral cavity cancer. We evaluated the predictive ability of the new staging system for oral cavity cancer to validate these changes and hypothesized that the new system would improve prognostic accuracy.Methods: We conducted a retrospective cohort study of patients with oral cavity squamous cell carcinoma in the National Cancer Data Base from 2009 to 2013 and applied the seventh and eighth edition staging AJCC staging systems to all patients. Stage-specific overall survival was calculated using the Kaplan-Meier method and concordance indices to measure the system's prognostic accuracy.Results: We identified 39,361 patients with a median follow-up of 27.1 months (range 0.1-80.4 months). In the seventh edition, there were 43.0%, 15.0%, 10.6%, and 25.7% of patients with pathologic stage I, II, III, and IV disease, respectively. After restaging based on eighth edition pathological guidelines, 10.0% of patients were upstaged (38.1%, 18.1%, 14.2%, and 25.2%, respectively, with stage I, II, III, and IV disease, respectively). The survival concordance index improved from the seventh to eighth edition for pathological staging (concordance index 0.699 and 0.704, respectively) and for clinical staging (concordance index 0.714 and 0.715, respectively).Conclusion: We provide validation of the new AJCC staging system for oral cavity cancer. Eighth edition AJCC staging guidelines upstage a substantial number of patients with greater depth of invasion or extranodal extension. This resulted in slightly improved prognostication.Level Of Evidence: 2c. Laryngoscope, 128:2351-2360, 2018. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Fellowship is the capstone of academic training and serves as preparation for an academic career. Fellows are expected to educate medical students and residents during and long after fellowship. However, little time is typically spent teaching fellows to become effective educators. We investigate a formal curriculum addressing teaching skills among fellows in otolaryngology-head and neck surgery (OHNS).Study Design: E-mail survey.Methods: We developed and implemented an educational program called Teach the Teacher to build skills as educators for fellows in OHNS. We conducted a survey of fellows from 2014 to 2017 in OHNS who participated in the course. The survey evaluated demographics, teaching experiences, and teaching limitations structured as yes/no and Likert-style questions (1 = strongly disagree, 5 = strongly agree).Results: Thirty fellows were surveyed with a response rate was 80%. Fellowship was rated highly as an experience that will make fellows a better academic educator (mean ± standard deviation: 4.54 ± 0.64). The most important components of teaching during fellowship were role modeling (4.67 ± 0.62), followed by teaching psychomotor skills in the operating room (4.29 ± 0.89), diagnostic reasoning (4.25 ± 0.66), and evidence-based medicine (4.25 ± 0.83). The Teach the Teacher course specifically was rated as a helpful experience (4.00 ± 0.90). The primary limitations to developing teaching skills during fellowship identified were lack of time, patient safety, and inexperience with hospital culture.Conclusions: Fellowship is a key time to improve skills as academic educators. Fellows value formal efforts to teach academic skills.Level Of Evidence: NA. Laryngoscope, 128:2034-2048, 2018. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Head and neck cancer patients have multiple risk factors for liver disease. However, little is known about the incidence of liver disease or the safety of surgery in these patients.Study Design: We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2013.Methods: We identified patients undergoing head and neck surgery and excluded them if preoperative laboratory data were missing. Patients were classified as having liver disease if their preoperative aspartate aminotransferase-to-platelet ratio index was ≥ 0.7, and as having advanced liver disease if their Model for End-Stage Liver Disease-Sodium score was ≥ 10. We compared the rate of postoperative complications using multivariable logistic regression.Results: Among 19,138 eligible patients, the incidence of any degree of liver disease was 6.8% for aerodigestive tract surgery and 3.3% for controls. The 30-day mortality rate after major head and neck surgery, which included composite resection; free tissue transfer; and total laryngectomy with advanced, mild, and no liver disease, was 14.6%, 3.0%, and 0.9%, respectively (P < 0.001). For nonmajor surgery, the mortality rate was 3.0%, 0.3%, and 0.3%, respectively (P < 0.001). On multivariable analysis, patients with advanced liver disease experienced a six-fold higher rate of 30-day mortality (odds ratio 6.1; 95% confidence interval, 2.9-12.8).Conclusion: There is a high risk to detect liver disease in patients undergoing head and neck surgery of the aerodigestive tract. Those with advanced liver disease are at high risk for perioperative mortality, and this risk should be judiciously considered in medical/surgical decision making and postoperative care.Level Of Evidence: 2c. Laryngoscope, 127:102-109, 2017. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: The conventional treatment for deep neck abscesses in adults is antibiotic therapy with surgical drainage, whereas in children there is debate about the role of surgical drainage versus conservative therapy. It is presently unclear if delayed surgical drainage negatively affects outcomes.Study Design: We performed a multicenter, prospective, risk-adjusted cohort study of adult and pediatric patients with deep neck abscess who received incision and drainage within 7 days of admission in the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2013 (adults) and from 2012 to 2013 (pediatrics).Methods: Patients were compared based on age (≤ 18 years, > 18 years), timing of surgical drainage (day 0, day 1-2, or day 3-7), and complication rates (specifically, abscess-specific morbidity and mortality [M&M]). Multivariate regression was performed to control for preoperative differences.Results: A total of 1,012 cases of deep neck abscess were identified (347 adult, 665 pediatric). In adults, delay in surgical drainage was associated with increased abscess-specific M&M, from 11.5% (day 0) to 17.3% (day 1-2) to 25.0% (day 3-7) (P = 0.02). On multivariate regression, delay in drainage of ≥ 3 days in adults was associated with a 2.38-fold increase in M&M (95% confidence interval 1.01-5.59, P = 0.019). In pediatrics, there was no association between surgical delay and increased abscess-specific M&M, with rates of 5.0% (day 0), 4.0% (day 1-2), and 4.8% (day 3-7) (P = 0.68).Conclusion: In adults, delay in surgical drainage of deep neck abscess is associated with increased M&M. There is no association between timing of drainage and M&M in children.Level Of Evidence: 2c. Laryngoscope, 126:1753-1760, 2016. [ABSTRACT FROM AUTHOR]

The article discusses the use of antibiotics which use to treat patients with acute rhinosinusitis (ARS) in ambulatory settings in the U.S. It examines the efficacy and safety of antibiotics for cost savings without sacrificing the quality of care for the ambulatory patients. It also cites the importance to maintain the quality of care for the patient in ambulatory services.

The authors convey their response to a feedback about their report on the epidemiology of tracheostomy-related death. Topics mentioned include deaths related to a tracheostomy complication among all death certificates in the U.S., errors in reporting of deaths because of tracheostomy complications, and factors that may contribute to underreporting of deaths related to a tracheostomy complication.