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Objective: We evaluate the safety of outpatient parotidectomy. We evaluate factors that lead to planned admission and compare costs. We evaluate trends toward outpatient, and the outcomes of switching admission status, total versus superficial approach, and ambulatory versus hospital site., Study Design: Retrospective cohort study., Setting: Single tertiary academic center., Methods: Retrospective review of patients who underwent parotidectomy for benign tumors from 2018 to 2023., Results: Of 370 parotidectomies performed, there were a planned 162 admissions and 208 outpatient procedures. A travel time > 60 minutes (odds ratio [OR] = 0.487, confidence interval [CI]: 0.296-0.803, P = .005) and total parotidectomy (OR = 0.448, CI: 0.226-0.89, P = .022) decreased the odds of a planned outpatient procedure. In a multivariable model, longer operative time increased the odds of switching to inpatient (n = 29, OR = 1.02, CI: 1.007-1.033, P = .002) and drain placement decreased the odds of switching to outpatient (n = 15, OR = 0.035, CI: 0.004-0.298, P = .002). There was no significant difference in surgical complications, phone calls, clinic visits, readmission rates, or recurrence between outpatient and inpatient. This remained true when comparing surgical facility and superficial versus total parotidectomy. After COVID was declared an emergency, there was a trend toward outpatient parotidectomy (72.7% vs 48.9%, P < .001), but no change in complication rates. At our institution, outpatient parotidectomy saved $3838 compared to overnight admission., Conclusion: This study supports that outpatient parotidectomy is safe. This remained true for patients switching admission status, undergoing superficial or total parotidectomy, and having their operation at an ambulatory site. We demonstrate that institutions can safely increase outpatient parotidectomy rates and outpatient parotidectomy is cost effective., (© 2024 The Author(s). Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objective: We evaluated vessel counts in the pharyngeal mucosal margins of patients who underwent salvage laryngectomy to establish whether mucosal vascularity might predict fistula risk., Study Design: Retrospective cohort., Setting: Tertiary Medical Center., Methods: Patients who underwent salvage total laryngectomy at our institution between 1999 and 2015 were identified. Pharyngeal mucosal margins from laryngectomy specimens were evaluated histologically for each patient, and vessel counts were performed on 5 ×10 images. The primary outcome measure was fistula within 30 days of surgery and mean vessel counts were assessed as the principle explanatory variable., Results: Seventy patients were included and 40% developed a postoperative fistula. There was a large difference in the mean vessel count in patients who did develop fistula (48.6 vessels/×10 field) compared to those who did not (34.7 vessels/×10 field). A receiver operative characteristic curve found that a cutoff value of 33.9 vessels/×10 field provided a sensitivity of 75% and specificity of 62% to predict the likelihood of fistula occurrence (area under the curve = 0.71, 95% confidence interval [CI]: 0.59-0.83). In a binary logistic regression, patients with vessel counts greater than 33.9 had a 5-fold increased risk of developing fistula (95% CI: 1.8-16.45). Histologically, vessels in the pharyngeal mucosa of patients who developed fistulas were more disorganized., Conclusion: After salvage laryngectomy, patients with higher mean mucosal margin vessel counts are at increased risk of fistula. The mechanism is unknown, but the disorganization of the vasculature may contribute to poor wound healing. Vessel counting may allow for fistula risk stratification and guide postoperative care., (© 2024 The Author(s). Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objective: Compare surgical and swallow outcomes in robotic versus traditional laryngeal cleft (LC) repairs., Study Design: Retrospective cohort study., Setting: Tertiary care pediatric hospital., Methods: Pediatric patients who underwent robotic or traditional (open or endoscopic) LC repair between 2010 and 2021 were identified. Patient characteristics, operative times, adverse events, hospital length of stay (LOS), and modified barium swallow study (MBSS) results were compared., Results: Eighteen robotic and thirty traditional LC repairs were identified. Mean surgical (149 vs 111 min, P < .05) and OR times (207 vs 139 min, P < .002) were increased for robotic type I LC repairs, but were similar for type II and III LC. Mean hospital LOS was increased for robotic type I LC repairs (2.6 vs 1.2 days, P < .006), but was decreased for type II (4 vs 12.2 days) and type III (4.3 vs 94.5 days) LC. Postoperative MBSS results were improved for robotic type I LC repairs at 12 months (82% vs 43%, P = .05), and trended toward improvement at 6 months for type II (75% vs 22%), and type III (67% vs 50%) LC repairs, although significance was limited for type II and III LC due to the number of subjects. A robotic approach was used successfully to revise all recurrent LC that failed traditional repairs., Conclusion: Robotic type 1 LC repairs demonstrated increased operative times and hospital LOS but improved postoperative swallow outcomes compared to traditional approaches may be particularly useful in cases of recurrent clefts., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)