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Objectives: To describe our center's experience with the identification and treatment of retrograde cricopharyngeus dysfunction (R‐CPD), a syndrome involving the inability to belch previously described by only one institution. Additionally, because all patients initially learned of their condition and sought treatment as a result of social media posts, we queried their source and comfort with this form of medical referral. Methods: Retrospective chart review of patients who underwent botulism toxin injection into the cricopharyngeus muscle for treatment of R‐CPD from 2019 to 2022. Demographic data, most common symptoms at presentation, and response to treatment and complications were documented. Post‐treatment questionnaires were reviewed. Results: A total of 85 patients were identified. Mean age at surgery was 27 years. There were 54 (63.5%) females and 31 (36.5%) males. The inability to burp (98.8%), bloating (92.9%), gurgling noises (31.8%), and excessive flatulence (21.2%) were the most common symptoms. The minimum units of botox utilized were 25, whereas the maximum was 100. The majority of patients (88.2%) had a successful response at initial follow‐up visit. The most common complication was mild dysphagia (30.6%), which was transient for all patients. Most patients learned of our practice through social media, with only one patient being referred by a medical provider. Conclusions: The majority of patients in our cohort were young and female. The inability to burp and bloating were the most common presenting symptoms. Social media was the primary source of referral. Our institution favors 80–100 units for an effective response. Laryngoscope, 133:1081–1085, 2023 [ABSTRACT FROM AUTHOR]

Objective: Massive bleeding requiring blood transfusion is a feared complication of endoscopic sinus surgery (ESS). In an effort to improve healthcare quality and outcomes, research is focused on identifying the risk factors for complications following surgical procedures. Blood transfusions have been linked to increased complication rates, but their role has not been extensively studied in ESS.Methods: The American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) participant user files 2005 to 2014 were queried for all cases of ESS. Patients were divided into cohorts based on anemia (hematocrit <39.00 in men and <36.00 in women) and hematocrit levels. Univariate analyses and a propensity score-matching algorithm were employed.Results: Of 630 cases of ESS, 117 (18.6%) had preexisting anemia. Anemic patients were more likely to be black (19.8% vs. 6.7%, P ≤ 0.001), undergo longer operation times (117.50 minutes ±155.73 vs. 129.85 minutes ±36.03, P = 0.005), have diabetes (28.2% vs. 10.9%, P ≤ 0.001), and have hypertension (46.2% vs. 33.1%, P = 0.010). Following propensity score matching, 109 cases were selected for each cohort, with no significant differences in demographics, comorbidities, operation time, or outpatient status. The anemic cohort was independently associated with an increase in overall postoperative complications (17.4% vs. 7.3%, P = 0.038). Transfusion use was significantly associated with preoperative hematocrit levels <30 (30.0% vs. 4.5%, P = 0.001) and between 30 and 34.99 (13.9% vs. 2.5%, P = 0.011).Conclusion: Preoperative anemia is a significant predictor of overall complications and bleeding requiring transfusion for patients undergoing ESS. These results highlight the need for careful preoperative assessment and management of anemia in this population.Level Of Evidence: NA Laryngoscope, 130:1377-1382, 2020. [ABSTRACT FROM AUTHOR]

Objective/hypothesis: Research has long been acknowledged as important to successfully matriculate into an otolaryngology residency position. The objective of this study is to perform a bibliometric analysis to quantify the importance of scholarly productivity in the otolaryngology match process.Study Design: Retrospective database review.Methods: A list of all Accreditation Council for Graduate Medical Education-accredited otolaryngology residency programs were identified. Websites of programs were reviewed to identify first-year otolaryngology residents for the 2016 to 2017 academic year and compared to two previous academic years. Research output measures were collected. Residencies were tiered 1 to 5 by departmental research output.Results: Two hundred twenty-two records of first-year otolaryngology residents starting residency in 2016 were identified. After adjusting for number of total publications, number of original research articles, number of review articles, number of case reports, number of first author publications, number of otolaryngology-related publications, highest journal impact factor, average journal impact factor, and years since publication, h-index and number of total publications were associated with increasing tier of matriculation based on research output (P < .0001). Only number of publications correlated with increasing h-index (B = 1.11). With regard to applicant trends, there has been an increase in scholarly productivity as measured across all research parameters in the past 3 years.Conclusions: Research is an important component of successfully matriculating into an otolaryngology residency program. The h-index is a reliable tool to quantify research output and predict the tier of matriculation with regard to institutional research output. There has been a steadily increasing level of scholarly output among applicants in the past 3 years.Level Of Evidence: NA Laryngoscope, 129:1561-1566, 2019. [ABSTRACT FROM AUTHOR]

Objectives: Parotidectomies have become a common outpatient procedure, but their impact on postoperative complications as compared to inpatient procedures has not been evaluated in a multi-institutional study.Study Design: The aim of this retrospective analysis was to evaluate the differences in outcomes using a standardized cohort of patients undergoing outpatient or inpatient parotidectomies.Methods: The National Surgical Quality Improvement Program database was queried for parotidectomies between 2005 and 2014. Univariate analyses were conducted to compare the outpatient and inpatient cohorts. A propensity-matching algorithm was used to ensure equal distribution of demographics and preoperative comorbidities.Results: Among the 4,368 parotidectomies examined, 2,915 (66.7%) were outpatient and 1,453 (33.3%) were inpatient. In the unmatched analysis, the inpatient group had higher rates of smokers (P = < 0.001), hypertension (P = 0.003), and disseminated cancer (P = 0.014). The outpatient group had higher rates of patients under age 40 years (P = 0.015), females (P = 0.016), and American Society of Anesthesiology class 1 and 2 (P = < 0.001). The total work relative value units (RVUs) were 17.01 ± 3.44 for the inpatient cohort and 16.19 ± 3.70 for the outpatient cohort (P = < 0.001). Following propensity matching, 1,352 cases were selected for each cohort, with no significant differences in comorbidities. Total work RVU after matching was 16.90 ± 3.47 for the inpatient group and 16.75 ± 3.44 for the outpatient group (P = .235). The matched inpatient cohort had increased rates of surgical complications (3.1% vs. 1.8%, P = 0.033), pneumonia (0.5% vs. 0.0%, P = 0.016), and overall complications (4.5% vs. 2.6%, P = 0.009).Conclusion: Outpatient parotidectomies are associated with similar as well as decreased complication rates as compared to inpatient parotidectomies.Level Of Evidence: 4 Laryngoscope, 129:655-661, 2019. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Evaluate risk factors for unplanned reoperation following free flap surgery of the head and neck.Study Design: Retrospective database review.Methods: The National Surgical Quality Improvement Program database was queried for free flap surgeries of the head and neck between 2010 and 2014. Bivariate and multivariate analyses were performed to compare perioperative variables and postoperative complications in patients with and without unplanned reoperation.Results: A total of 1,796 patients were identified, with an overall unplanned reoperation rate of 20.0% (n = 359) within 30 days after surgery. Upon multivariate analysis, independent preoperative risk factors for unplanned reoperation include smoking (odds ratio [OR]: 1.389, 95% confidence interval [CI]: 1.042-1.850), hypertension (OR: 1.443, 95% CI: 1.096-1.901), and prior open wound/wound infection (OR: 1.675, 95% CI: 1.123-2.499). Intraoperative risk factors include prolonged operative time (OR: 1.045, 95% CI: 1.021-1.070). Surgical site infection (OR: 6.518, 95% CI: 2.728-15.574), wound disruption (OR: 17.034, 95% CI: 8.373-34.654), blood transfusion (OR: 1.561, 95% CI: 1.062-2.296), and ventilation > 48 hours (OR: 3.626, 95% CI: 1.955-6.723) were significant postoperative predictors of unplanned reoperation.Conclusions: In patients with free flap surgeries of the head and neck, preoperative smoking, hypertension, and prior open wound/wound infection, along with prolonged operative time, are risk factors for 30-day unplanned reoperation. In addition, postoperative surgical site infection, wound disruption, blood transfusion, and ventilation >48 hours are independently associated with unplanned reoperation.Level Of Evidence: 4 Laryngoscope, 128:2790-2795, 2018. [ABSTRACT FROM AUTHOR]