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Objective: Head and neck cancers (HNCs) have increased in prevalence and often require free‐flap reconstruction (FFR) after tumor ablation. Postoperative complications following FFR can be high, occurring in as many as 48% and 71% of cases. HNC patients also have many disparities in Social Determinants of Health (SDOH), but the potential impact of SDOH disparities on postoperative complications following FFR has not been formally assessed. Study Design: Retrospective cohort review. Setting: Academic Tertiary Care Institution in Northeast United States. Methods: Patients that underwent head and neck FFR between January 2018 and December 2021 were analyzed to determine associations between quartiles of the national Area Deprivation Index (ADI), a proxy for SDOH disparity, and various medical and surgical postoperative complications. Associations were assessed using χ2 analysis. Results: Two hundred four patients were included in the study, and 61 patients had 97 complications. Significant associations between higher national ADI quartile and incidence of several postoperative complications were identified, including any surgical complication (P =.0419), wound dehiscence (P =.0494), myocardial infarction (MI) (P =.0215), and sepsis (P =.0464). Conclusion: There are significant associations between SDOH disparities and postoperative surgical complications, wound dehiscence, MI, and sepsis following head and neck FFR. Addressing SDOH disparities in HNC is pivotal to enhance postoperative outcomes and promote holistic patient care. [ABSTRACT FROM AUTHOR]

Objective: The modified frailty index (mFI‐5) is a National Surgical Quality Improvement Program‐derived 5‐factor index that has been proven to reflect frailty and predict morbidity and mortality. We hypothesize that mFI‐5 is a valid predictive measure in the transoral robotic surgery (TORS) population. Methods: Retrospective study utilizing the TriNetX US‐collaborative health records network querying for TORS patients. Cohorts were stratified by mFI‐5 score which uses five ICD‐10 codes: nonindependent functional status, hypertension, obstructive respiratory disease, heart failure, and diabetes mellitus. Cohorts were matched by age using propensity score matching. Outcome measures included survival, infection, pneumonia, tracheostomy dependence, and percutaneous endoscopic gastrostomy dependence. Reported odds ratios were normalized to mFI‐5 = 0. Results: A total of 9,081 patients were included in the final analysis. Greater mFI‐5 scores predicted decreased survival and increased incidence of postoperative infection and pneumonia. Odds of 5‐year mortality were 1.93 (p = 0.0003) for mFI‐5 = 2 and 1.90 (p = 0.0002) for mFI‐5 = 3. Odds of 2‐year mortality were 1.25 (p = 0.0125) for mFI‐5 = 1, 1.58 (p = 0.0002) for mFI‐5 = 2, and 1.87 (p = 0.003) for mFI‐5 = 3. Odds of postoperative infection were 1.51 (p = 0.02) for mFI‐5 = 2 and 1.78 (p = 0.05) for mFI‐5 = 3. Two‐year odds of developing pneumonia were 1.69 (p = 0.0001) for mFI‐5 = 2 and 2.84 (p < 0.0001) for mFI‐5 = 3. Two‐month odds of pneumonia were 1.50 (p = 0.0259) for mFI‐5 = 2 and 2.55 (p = 0.0037) for mFI‐5 = 3. mFI‐5 = 4 or 5 had too few patients to analyze. Using polynomial regression to model age versus incident 5‐year post‐TORS death (R2 = 0.99), mFI‐5 scores better predicted survival than age alone. Conclusion: This study demonstrates that mFI‐5 predicts mortality, pneumonia, and postoperative infection independently of age. Level of Evidence: 4 Laryngoscope, 134:4278–4283, 2024 [ABSTRACT FROM AUTHOR]

Background: There is sparse literature on the effect of preoperative immunotherapy on complications after surgery for primary head and neck squamous cell carcinoma (HNSCC). The objectives are to compare complication rates in patients receiving surgery with and without neoadjuvant immune checkpoint inhibitors (nICI) for primary HNSCC and to evaluate factors associated with increased odds of surgical complications. Methods: A retrospective review of patients who underwent ablation and free flap reconstruction or transoral robotic surgery (TORS) for primary HNSCC between 2017–2021 was conducted. Complications were compared between patients who underwent surgery with or without nICI before and after propensity score matching. Regression analysis to estimate odds ratios was performed. Results: A total of 463 patients met inclusion criteria. Free flap reconstruction constituted 28.9% of patients and TORS constituted 71.1% of patients. nICI was administered in 83 of 463 (17.9%) patients. There was no statistically significant difference in surgical, medical, or overall complications between patients receiving surgery with or without nICI. In the unmatched cohort, multivariable model identified non‐White race, former/current smoking history, free flap surgery, and perineural invasion as factors significantly associated with increased complications. In the matched cohort, multivariable model identified advanced age and free flap surgery as factors significantly associated with increased complications. Plain Language Summary: It is safe to give immunotherapy before major surgery in patients who have head and neck cancer.Advanced age, non‐White race, current/former smoking, free flap surgery, and perineural invasion may be associated with increased the odds of surgical complications. In this study, neoadjuvant immune checkpoint inhibitors (nICI) did not increase the risk of overall complications after adjusting for important confounders. Definitive surgery can be conducted safely after nICI. [ABSTRACT FROM AUTHOR]

Objective: To assess whether preoperative tracheostomy (PreOT) increases risk of complications after total laryngectomy (TL) and to determine if timing of tracheostomy creation is associated with an increased risk. Study Design: Retrospective cohort study. Setting: Tertiary care hospital between 2007 and 2020. Methods: Inclusion criteria were patients who underwent primary or salvage TL for oncologic treatment. Dependent variables of interest included surgical complications, such as wound dehiscence, infection, hematoma, complete flap failure, fistula formation, and stoma stenosis, as well as medical complications. Categorical variables were compared with chi‐square test or Fisher exact test, and continuous variables were compared with an independent t test. Multivariable regression was conducted to assess predictors of complications after laryngectomy. Results: A total of 306 patients were included. Primary TL was performed in 161 (53%) patients and salvage in 145 (47%) patients. Of the patients undergoing primary laryngectomy, 105 (65%) received a PreOT. Of the patients undergoing salvage laryngectomy, 86 (59%) received a PreOT. In both primary and salvage cases, there was no association between PreOT and surgical or medical complications. Additionally, there was no significant association between timing of tracheostomy and surgical complications. On multivariable analysis, the presence of a PreOT was not associated with surgical complications. In salvage cases, those with a PreOT had a significantly longer average length of stay than those without a PreOT (12 vs 9 days, P =.008). Conclusion: PreOT in patients undergoing primary and salvage laryngectomies was not associated with surgical or medical complications postlaryngectomy. Timing of tracheostomy in relation to laryngectomy was not found to adversely affect clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: The Chronic Obstructive Sialadenitis Symptoms questionnaire (COSS) was created to assess chronic sialadenitis symptoms and treatment response, but its development lacked patient input and validation. We analyzed COSS responses and feedback from sialadenitis patients and physician experts to create the novel obstructive Salivary Problem Impact Test (SPIT), a new standardized measure of sialadenitis‐associated symptoms. Methods: We analyzed COSS responses via exploratory factor analysis (EFA) to identify essential symptom domains and reduce overlap in questions. Sialadenitis patients evaluated the significance of index symptoms identified from the literature review. Expert physicians rated symptom relevance in clinical assessment. An updated questionnaire (SPIT) was piloted with both patient and expert interviews to optimize structure and readability. The SPIT was assessed for internal consistency, construct validity, and test–retest stability. Results: EFA of 310 COSS responses demonstrated 3 main symptom domains (functional impact, pain, swelling) that explained 58.4% of response variance. Results were not statistically different when collapsing from 11 to 5 question response options. Experts (n = 5) ranked gland swelling, mealtime pain, and foul taste as most clinically important, while patients (n = 12) ranked swelling, non‐mealtime pain, and difficulty eating as most bothersome. Most patients experienced sialadenitis‐related functional or psychosocial impairment. Following interviews for question refinement, a 25‐question survey was finalized. SPIT responses from 50 sialadenitis patients demonstrated internal consistency (Cronbach's alpha = 0.96), 14‐day stability (p < 0.001), and agreement with Oral Health Impact Profile‐14 scores (p < 0.0001). Conclusions: We developed the SPIT instrument to improve usability and content validity in chronic sialadenitis evaluation. The psychometric assessment demonstrated high construct validity and test–retest reliability. Further work will assess longitudinal changes with treatment. Level of Evidence: 4 Laryngoscope, 133:539–546, 2023 [ABSTRACT FROM AUTHOR]

Objectives: Patients are increasingly relying on YouTube for health information. We objectively evaluated the quality and comprehensiveness of sialendoscopy YouTube videos available to patients. We further investigated the relationship between video content and video popularity. Methods: We identified 150 videos using the search term "sialendoscopy." Videos were excluded if they were lectures for medical professionals, operating room (OR) recordings, unrelated, non‐English, or non‐audio. Video quality and comprehensiveness were evaluated using modified DISCERN criterion (range: 5–25) and novel sialendoscopy criterion (NSC, range: 0–7), respectively. Secondary outcomes included standard video metrics and Video Power Index to measure popularity. Videos were classified binarily by uploader type as from an academic medical center or from other sources. Results: Twenty‐two (14.7%) of 150 videos were included for review, with 7 (31.8%) uploaded from academic medical institutions. One hundred‐nine (72.7%) videos were excluded as lectures for medical professionals or OR recordings. Overall mean modified DISCERN (13.45 ± 3.42) and NSC (3.05 ± 0.96) scores were low; however, videos uploaded by academic medical institutions were significantly more comprehensive (NSC mean difference = 0.98, 95% CI: 0.16–1.80, p =.02). There were no significant correlations between video popularity and objective measures of quality or comprehensiveness. Conclusions: This study highlights the paucity and low quality of sialendoscopy videos for patients. More popular videos are not higher quality, and most videos are targeted more toward physicians rather than patients. As YouTube becomes increasingly used by patients, there is opportunity for otolaryngologists to produce more informative videos for patients while implementing targeted strategies to increase viewership. Level of Evidence: NA. [ABSTRACT FROM AUTHOR]