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Bhatt N, Yang J, DeBaere L, Wang RS, Most A, Zhang Y, Dayanov E, Yang W, Santacatterina M, Kamberi M, Mojica J, Kamen E, Savitski J, Stein J, Jacobson A. Reducing Length of Stay in Reconstructive Head and Neck Surgery Patients: A Quality Improvement Initiative. Otolaryngol Head Neck Surg 2024. [PMID: 39118499 DOI: 10.1002/ohn.933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 06/14/2024] [Accepted: 06/24/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To investigate whether a new preoperative education and discharge planning protocol reduced unexpected discharge delays for patients undergoing reconstructive surgery for head and neck cancer. METHODS A quality improvement (QI) intervention was implemented in January 2021 with several components to address historically prolonged observed lengths of stay (LOS) with head and neck cancer patients. The intervention added a preoperative educational visit with a head and neck cancer advanced practice provider, a standardized preoperative speech and swallow assessment, a personalized patient care plan document, discussion of inpatient hospital stay expectations, and early discharge planning. The intervention group included patients who underwent the preoperative education protocol from February to December 2021. For comparison, an age and sex-matched control group was constructed from inpatients who had been admitted for similar procedures in the 2 years prior to the QI intervention (2019-2020) and received standard of care counseling. RESULTS Our study demonstrated a significant reduction in observed to expected LOS ratio after implementation of the intervention (1.24 ± 0.74 control, 0.95 ± 0.52 intervention; P = .012). DISCUSSION We discuss a preoperative education QI intervention at our institution. Our findings demonstrate that our intervention was associated with decreased LOS for patients undergoing head and neck reconstructive surgeries. IMPLICATIONS FOR PRACTICE This QI study shows the benefit of a new standardized preoperative education and discharge planning protocol for patients undergoing head and neck reconstructive surgeries.
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Affiliation(s)
- Nupur Bhatt
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Jackie Yang
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Lauren DeBaere
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Ronald Shen Wang
- New York University Grossman School of Medicine, New York City, New York, USA
| | - Allison Most
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Yan Zhang
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Elan Dayanov
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Wenqing Yang
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | | | - Maria Kamberi
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Jacqueline Mojica
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Emily Kamen
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Justin Savitski
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - John Stein
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Adam Jacobson
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
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Duckett KA, Kassir MF, Nguyen SA, Brennan EA, Chera BS, Sterba KR, Halbert CH, Hill EG, McCay J, Puram SV, Jackson RS, Sandulache VC, Kahmke R, Osazuwa-Peters N, Ramadan S, Nussenbaum B, Alberg AJ, Graboyes EM. Factors Associated with Head and Neck Cancer Postoperative Radiotherapy Delays: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024. [PMID: 38842034 DOI: 10.1002/ohn.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/02/2024] [Accepted: 05/12/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE Initiating postoperative radiotherapy (PORT) within 6 weeks of surgery for head and neck squamous cell carcinoma (HNSCC) is included in the National Comprehensive Cancer Network Clincal Practice Guidelines and is a Commission on Cancer quality metric. Factors associated with delays in starting PORT have not been systematically described nor synthesized. DATA SOURCES PubMed, Scopus, and CINAHL. REVIEW METHODS We included studies describing demographic characteristics, clinical factors, or social determinants of health associated with PORT delay (>6 weeks) in patients with HNSCC treated in the United States after 2003. Meta-analysis of odds ratios (ORs) was performed on nonoverlapping datasets. RESULTS Of 716 unique abstracts reviewed, 21 studies were included in the systematic review and 15 in the meta-analysis. Study sample size ranged from 19 to 60,776 patients. In the meta-analysis, factors associated with PORT delay included black race (OR, 1.46, 95% confidence interval [CI]: 1.28-1.67), Hispanic ethnicity (OR, 1.37, 95% CI, 1.17-1.60), Medicaid or no health insurance (OR, 2.01, 95% CI, 1.90-2.13), lower income (OR, 1.38, 95% CI, 1.20-1.59), postoperative admission >7 days (OR, 2.92, 95% CI, 2.31-3.67), and 30-day hospital readmission (OR, 1.37, 95% CI, 1.29-1.47). CONCLUSION Patients at greatest risk for a delay in initiating guideline-adherent PORT include those who are from minoritized communities, of lower socioeconomic status, and experience postoperative challenges. These findings provide the foundational evidence needed to deliver targeted interventions to enhance equity and quality in HNSCC care delivery.
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Affiliation(s)
- Kelsey A Duckett
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohamed Faisal Kassir
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily A Brennan
- MUSC Libraries, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bhisham S Chera
- Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jessica McCay
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- ENT Section, Operative CareLine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Salma Ramadan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Brian Nussenbaum
- American Board of Otolaryngology-Head and Neck Surgery, Houston, Texas, USA
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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3
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Palmer AD, Starmer H, Sathe N, Yao TJ, Bolognone RK, Edwards J, Crino C, Kizner J, Graville DJ. Use of the G8 Geriatric Screening Tool in Surgical Head and Neck Cancer Patients Requiring Rehabilitation: A Multisite Investigation. Ann Otol Rhinol Laryngol 2024; 133:158-168. [PMID: 37551009 DOI: 10.1177/00034894231191869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVES The G8 is a well-validated screening test for older cancer patients. The current study was undertaken to determine whether the G8 is predictive of short-term post-operative outcomes after head and neck cancer (HNC) surgery. METHODS Consecutive patients aged 65 years or more and referred for a preoperative assessment by a speech-language pathologist were consecutively screened by clinicians at 2 academic medical centers using the G8. The G8 was used to screen for vulnerability prior to surgery. Patients were deemed vulnerable if they had a total G8 score ≤14 according to published guidelines. Data were also collected on demographic characteristics, tumor staging, post-operative course, and tracheostomy and feeding tube (FT) status. RESULTS Ninety patients were consecutively screened during the study period. Using the G8, 64% of the patients were deemed vulnerable. Vulnerable patients differed significantly from non-vulnerable patients with regard to age, health, tumor stage, and baseline dysphagia, and underwent more extensive surgery. Postoperatively, vulnerable patients had a significantly longer hospital length of stay (LOS; 10.17 vs 5.50 days, respectively, P < .001), were less likely to discharge home (76% vs 94%, P = .044), and were more likely to be FT dependent for over a month (54% vs 21%, P = .006) compared to non-vulnerable patients. In regression models, controlling for T-stage and surgical variables, the G8 independently predicted 2 post-operative outcomes of interest, namely LOS and FT dependency. CONCLUSIONS The G8 may be a useful screening tool for identifying older adults at risk of a protracted postoperative medical course after HNC surgery. Future research should aim to identify the optimal screening protocol and how this information can be incorporated into clinical pathways to enhance the post-operative outcomes of older HNC patients.
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Affiliation(s)
- Andrew D Palmer
- Northwest Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Heather Starmer
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, CA, USA
| | - Nishad Sathe
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Theresa Jingyun Yao
- Head and Neck Speech and Swallowing Rehabilitation Center, Stanford Healthcare, Stanford, CA USA
| | - Rachel K Bolognone
- Northwest Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Jeffrey Edwards
- Head and Neck Speech and Swallowing Rehabilitation Center, Stanford Healthcare, Stanford, CA USA
| | - Carrie Crino
- Northwest Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer Kizner
- Head and Neck Speech and Swallowing Rehabilitation Center, Stanford Healthcare, Stanford, CA USA
| | - Donna J Graville
- Northwest Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
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Rammal A, Alqutub A, Alsulami O, Mozahim N, Mozahim S, Awadh M, Hakami M, AlThomali R, Mogharbel A. Total laryngectomy and readmission: causes, rates and predictors. BMC Res Notes 2023; 16:377. [PMID: 38124147 PMCID: PMC10731825 DOI: 10.1186/s13104-023-06645-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Total laryngectomy (TL) is a complex procedure, and patients undergoing TL are at high risk for readmission, which exposes them to hospital-acquired complications. Readmission rate is a metric for quality of care. We aimed to identify the rate, causes, and predictors of hospital readmission within 60 days after discharge following TL. METHODS This is a 12-year retrospective study where we included all patients undergoing TL in a single tertiary care center between 2008 and 2022. Patient charts were reviewed for demographics, comorbidities, and causes for readmission. RESULTS Of 83 patients who underwent TL, 12 (14.50%) were readmitted within 60 days. Common causes were surgical site infection (33.33%) and mucocutaneous fistula (25%). Significant predictors for readmission were tobacco use (P = 0.003), African ethnicity (P = 0.004), being unmarried (P < 0.001), lower preoperative serum albumin (P < 0.001), higher preoperative TSH (P = 0.03), higher preoperative neutrophil count (P = 0.035), higher American Society of Anesthesiology (ASA) score (P = 0.028), and higher Cumulative Illness Rating Scale (CIRS) score (P = 0.029). CONCLUSION One in every seven patients were readmitted following TL. Frequent causes include wound infection and fistulas. Predictors include preoperative hypoalbuminemia, hypothyroidism, African ethnicity, being unmarried, tobacco use, and a higher baseline burden of comorbidities. Such factors can be targeted to reduce hospital readmission rates.
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Affiliation(s)
- Almoaidbellah Rammal
- Otolaryngology-Head and Neck Surgery Department, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulsalam Alqutub
- Otolaryngology-Head and Neck Surgery Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Omar Alsulami
- Otolaryngology-Head and Neck Surgery Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Naif Mozahim
- Otolaryngology-Head and Neck Surgery Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sara Mozahim
- Otolaryngology-Head and Neck Surgery Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Awadh
- Otolaryngology-Head and Neck Surgery Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muatasaim Hakami
- Otolaryngology-Head and Neck Surgery Department, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rahaf AlThomali
- Otolaryngology-Head and Neck Surgery Department, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Mogharbel
- Otolaryngology-Head and Neck Surgery Department, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
- Otolaryngology-Head and Neck Surgery Department, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
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Nyirjesy SC, Zhao S, Judd R, McCrary H, Kuhar HN, Farlow JL, Seim NB, Rocco JW, Kang SY, Haring CT. Hypothyroidism as an Independent Predictor of 30-day Readmission in Head and Neck Cancer Patients. Laryngoscope 2023; 133:2988-2998. [PMID: 36974971 DOI: 10.1002/lary.30675] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES To define the role of hypothyroidism and other risk factors for unplanned readmissions after surgery for head and neck cancer. STUDY DESIGN Retrospective cohort study. METHODS The Nationwide Readmission Database (NRD) was used to identify patients who underwent surgery for mucosal head and neck cancer (oral cavity, oropharynx, larynx, and hypopharynx) between 2010 and 2017. Univariate and multivariate logistic regression were performed to determine patient, tumor, and hospital related risk factors for 30-day readmission. Readmitted patients were stratified by preoperative diagnosis of hypothyroidism to compare readmission characteristics. RESULTS For the 131,013 patients who met inclusion criteria, the readmission rate was 15.9%. Overall, 11.91% of patients had a preoperative diagnosis of hypothyroidism. After controlling for other variables, patients with a preoperative diagnosis of hypothyroidism had 12.2% higher odds of readmission compared to those without hypothyroidism (OR: 1.12, 1.03-1.22, p = 0.008). Patients with hypothyroidism had different reasons for readmission, including higher rates of wound dehiscence, fistula, infection, and electrolyte imbalance. Among readmitted patients, the length of stay for index admission (mean 10.5 days vs. 9.2 days, p < 0.001), readmission (mean 7.0 vs. 6.6 days, p = 0.05), and total hospital charge were higher for hypothyroid patients ($137,742 vs. $119,831, p < 0.001). CONCLUSION Hypothyroidism is an independent risk factor for 30-day readmission following head and neck cancer resection. Furthermore, hypothyroid patients are more likely to be readmitted for wound complications, infection, and electrolyte imbalance. Targeted interventions should be considered for hypothyroid patients to decrease readmission rates and associated patient morbidity, potentially leading to earlier initiation of adjuvant treatment. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2988-2998, 2023.
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Affiliation(s)
- Sarah C Nyirjesy
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, 320 Lincoln Tower, 1800 Cannon Drive, Columbus, Ohio, 43210, USA
| | - Ryan Judd
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Hilary McCrary
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Hannah N Kuhar
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Janice L Farlow
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Nolan B Seim
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - James W Rocco
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Stephen Y Kang
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Catherine T Haring
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
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List MA, Knackstedt M, Liu L, Kasabali A, Mansour J, Pang J, Asarkar AA, Nathan C. Enhanced recovery after surgery, current, and future considerations in head and neck cancer. Laryngoscope Investig Otolaryngol 2023; 8:1240-1256. [PMID: 37899849 PMCID: PMC10601592 DOI: 10.1002/lio2.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/15/2022] [Indexed: 10/31/2023] Open
Abstract
Objectives Review of the current and relevant literature to develop a list of evidence-based recommendations that can be implemented in head and neck surgical practices. To provide rationale for the multiple aspects of comprehensive care for head and neck surgical patients. To improve postsurgical outcomes for head and neck surgical patients. Methods Extensive review of the medical literature was performed and relevant studies in both the head and neck surgery and other surgical specialties were considered for inclusion. Results A total of 18 aspects of perioperative care were included in this review. The literature search included 276 publications considered to be the most relevant and up to date evidence. Each topic is concluded with recommendation grade and quality of evidence for the recommendation. Conclusion Since it's conception, enhanced recovery after surgery (ERAS) protocols have continued to push for comprehensive and evidence based postsurgical care to improve patient outcomes. Head and neck oncology is one of the newest fields to develop a protocol. Due to the complexity of this patient population and their postsurgical needs, a multidisciplinary approach is needed to facilitate recovery while minimizing complications. Current and future advances in head and neck cancer research will serve to strengthen and add new principles to a comprehensive ERAS protocol. Level of Evidence 2a.
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Affiliation(s)
- Marna A. List
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Mark Knackstedt
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Lucy Liu
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Ahmad Kasabali
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
- College of MedicineLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Jobran Mansour
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - John Pang
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Ameya A. Asarkar
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
- Feist‐Weiller Cancer CenterShreveportLouisianaUSA
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Charles RA, Abouhassan S, McFarland H, Pronovost PJ. Prescribing Narcotics for Pain: Reconsider the Fifth Vital Sign. ANNALS OF SURGERY OPEN 2022; 3:e186. [PMID: 37601150 PMCID: PMC10431489 DOI: 10.1097/as9.0000000000000186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ronald A. Charles
- Department of Surgery, Case Western Reserve University, School of Medicine, Cleveland, OH
- Division of Colon & Rectal Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Soozan Abouhassan
- Department of Anesthesiology and Perioperative Medicine, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Heather McFarland
- Department of Anesthesiology and Perioperative Medicine, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Peter J. Pronovost
- Department of Anesthesia and Perioperative Medicine, University Hospitals, Cleveland, OH
- Department of Anesthesiology and Critical Care Medicine, Case Western Reserve University, School of Medicine, Cleveland, OH
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Foley J, Burns CL, Ward EC, Nund RL, Wishart LR, Kenny LM, Stevens M. Post-acute health care needs of people with head and neck cancer: Mapping health care services, experiences, and the impact of rurality. Head Neck 2022; 44:1377-1392. [PMID: 35319137 PMCID: PMC9313784 DOI: 10.1002/hed.27037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/26/2022] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with head and neck cancer (HNC) have complex health care needs; however, limited evidence exists regarding the nature or patterns of service access and use. This study explored the post-discharge health care needs and experiences of individuals with HNC from metropolitan and rural areas. METHODS Health care appointments and services accessed by people with HNC were collated for 6-month post-treatment. Data analysis of the whole cohort examined patterns of access while journey mapping integrated participants' experiences of recovery. RESULTS The 6-month service access journey was mapped for 11 people. Rural participants attended a significantly greater number of appointments (p = 0.012), higher canceled/missed appointments (p = 0.013), and saw more professionals (p = 0.007). Rural participants reported higher stress and burden due to service access barriers and unmet needs. CONCLUSIONS Multiple challenges and inequities exist for rural people with HNC. Findings inform opportunities to enhance the post-treatment recovery of people with HNC in rural areas.
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Affiliation(s)
- Jasmine Foley
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland
| | - Clare L Burns
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland.,The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland.,Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Rebecca L Nund
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland
| | - Laurelie R Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland.,Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,Division of Cancer Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Lizbeth M Kenny
- The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Maurice Stevens
- The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
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9
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Schmid M, Giger R, Nisa L, Mueller SA, Schubert M, Schubert AD. Association of Multiprofessional Preoperative Assessment and Information for Patients With Head and Neck Cancer With Postoperative Outcomes. JAMA Otolaryngol Head Neck Surg 2022; 148:259-267. [PMID: 35050322 PMCID: PMC8778600 DOI: 10.1001/jamaoto.2021.4048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IMPORTANCE Multidisciplinary perioperative assessment for patients undergoing complex oncologic head and neck cancer (HNC) surgery is widely implemented. However, to our knowledge, the association of multiprofessional preoperative assessment, information, and briefing with postoperative outcomes has not been evaluated. OBJECTIVE To compare postoperative complications, length of hospital stay (LOS), readmissions, mortality, and costs per case among patients undergoing complex oncologic HNC surgery before and after the implementation of a comprehensive preoperative multiprofessional assessment and information day (MUPAID). DESIGN, SETTING, AND PARTICIPANTS This retrospective, single-center case-control study was conducted at a tertiary referral head and neck anticancer center/university cancer institute and compared patients with HNC who were undergoing complex oncological surgeries between January 2012 and July 2018 before (control group) and after (intervention group) implementation of the institutional MUPAID. Data analysis was conducted between 2019 and 2020. The intervention group comprised patients who participated in the MUPAID beginning in February 2015. These patients were assessed by a multiprofessional team and provided with structured and comprehensive information on the surgical procedure and its functional, social, financial, and psychological effects, as well as the postoperative care, rehabilitation, and follow-up period. Patients in the control group had also undergone complex oncologic HNC surgery and were selected through surgical procedure codes. MAIN OUTCOMES AND MEASURES The end points were postoperative rate and severity of complications, LOS, readmissions, mortality, and costs per case. RESULTS The study included 161 patients, 81 in the intervention (25 women [30.9%]) and 80 in the control group (18 women [22.5%]). The groups showed no relevant differences in sociodemographic, disease, and procedural characteristics. The intervention cohort presented with fewer major local and systemic complications (Clavien-Dindo score, III-V: 34.6% vs 52.5%; difference proportion, -0.179; 95% CI, -0.33 to -0.03), shorter median LOS (12 days [IQR, 10-16 days] vs 16 days [IQR, 11-20] days; effect size, 0.482; 95% CI Cohen d, 0.152-0.812) and decreased median charge per case ($50 848 [IQR, $42 510-$63 479] vs $69 602 [IQR, $45 631-$96 280]; effect size, 0.534; 95% CI Cohen d, 0.22-0.85). CONCLUSIONS AND RELEVANCE The results of this case-control study suggest that MUPAID for patients who are undergoing complex oncologic HNC surgery is associated with shortened LOS and costs per case as well as decreased complications severity. These results are promising on a patient level in the potential to minimize individual treatment burden, as well as on an institutional and health care system level in the potential significant optimization of surgical outcomes and financial aspects.
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Affiliation(s)
- Manuela Schmid
- Department of Nursing, Medical-Technical and Medical-Therapeutic Areas, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lluís Nisa
- Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Andreas Mueller
- Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria Schubert
- School of Health Professions, Zurich University of Applied Science, Winterthur, Switzerland,Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Adrian Daniel Schubert
- Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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10
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Yang Y, Zhang H, Li Y, Liu Z, Liu S, Li X, Fan G, Xu Y, Wang BQ. The effectiveness of computer-assisted Cognitive Behavioral Therapy (cCBT) for psychological outcomes in patients with laryngectomy: Randomized controlled trial. J Affect Disord 2022; 300:59-65. [PMID: 34942224 DOI: 10.1016/j.jad.2021.12.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/30/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The symptom burden was tremendous and rates of psychological distress were high because of laryngectomy in Laryngeal carcinoma. Anxiety and depression as mainly psychological distress influenced their sleep, pain, and the quality of life (QOL). This study aimed to assess the effiacy of computer-assisted Cognitive Behavioral Therapy (cCBT) for psychological outcomes and QOL in patients with laryngectomy, in addition to overall experience with health care service, during the perioperative period. METHODS A cCBT program was be customized focused on improving anxiety and depressive symptoms among patients with laryngectomy, and then its effectiveness was assessed. Participants were randomly assigned to the TAU (treatment as usual) group (n=40) or CCBT group (cCBT+ TAU, n = 40). The primary outcome measures were the State Anxiety Inventory (SAI), Patients Health Questionnaire-9 (PHQ-9). The secondary outcome measures were the Athens Insomnia Scale (AIS), Visual Analogue Scale-10 (VAS-10). The outcomes were obtained from patients before intervention (T1), 1 hour before surgery (T2), postoperative 3-day (T3), postoperative 7-day (T4), and postoperative 10-day(T5: after intervention completed). Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) and satisfaction for health care service were assessed before discharge. RESULTS A mixed linear model displayed significant improvement in symptoms of anxiety, depression, insomnia, and pain in the two groups (all p<0.001); and revealed a significant decreasing on the SAI, PHQ-9, AIS, and VAS-10 scores in the CCBT group compared to that of TAU group during the post-intervention periods (all p<0.05). Furthermore, the other QOL of patients were higher except for physical well-being (p=0.176) and the satisfaction scores were higher in the CCBT group than that of TAU group (all p<0.05). CONCLUSION The new developed cCBT program has a positive effect on psychosomatic symptoms surgery-related among patients with laryngectomy,. And patients with cCBT program reported high levels of QOL and satisfaction during perioperative period. To minimize face-to-face contact, the computer-assisted intervention may be an attractive approach.
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Affiliation(s)
- Yang Yang
- Nursing Department, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Key Laboratory of Brain Science and Neuropsychiatric Diseases, China
| | - Haibin Zhang
- Department of anesthesia, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuling Li
- Nursing Department, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhifen Liu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Sha Liu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xinrong Li
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Gaiping Fan
- Department of Head and Neck Surgery, Shanxi provincial Cancer Hospital, Taiyuan, China
| | - Yong Xu
- Shanxi Key Laboratory of Brain Science and Neuropsychiatric Diseases, China; Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
| | - Bin-Quan Wang
- Department of Otorhinolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
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11
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Kamal M, Baudo M, Shmushkevich S, Geng Y, Hanna E, Goepfert RP, Lewis CM, Rahouma M. COVID-19 infection and its consequences among surgical oncology patients: A systematic analysis, meta-analysis and meta-regression. J Surg Oncol 2022; 125:813-823. [PMID: 35014703 PMCID: PMC9015254 DOI: 10.1002/jso.26787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022]
Abstract
We conducted this meta‐analysis to address the outcomes in cancer patients after oncologic surgery during COVID‐19 pandemic. The primary endpoint was the COVID‐19–related mortality rate. Higher body mass index was significantly and negatively associated with higher all‐cause mortality and in‐hospital COVID‐19 infection rates. Male sex, preoperative respiratory disease, and smoking history were positively and significantly associated with increased all‐cause mortality rates. Furthermore, male sex was positively and significantly associated with the COVID‐19 infection rate.
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Affiliation(s)
- Mona Kamal
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Massimo Baudo
- Department of Cardiac Surgery, Spedali Civili di Brescia, Brescia, Italy
| | - Shon Shmushkevich
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Cardiothoracic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York City, New York, USA
| | - Yimin Geng
- Division of Education & Training, Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ehab Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carol M Lewis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohamed Rahouma
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Giza, Egypt
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12
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Tokat T, Muderris T, Aysel A, Sari E, Erol F. The efficiency of polyglycolic acid felt in the prevention of pharyngocutaneous fistula after total laryngectomy. Am J Otolaryngol 2021; 42:103164. [PMID: 34352675 DOI: 10.1016/j.amjoto.2021.103164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/17/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Taskin Tokat
- Department of Otolaryngology - Head and Neck Surgery, Sakarya University Education and Research Hospital, Sakarya, Turkey.
| | - Togay Muderris
- Department of Otolaryngology - Head and Neck Surgery, Bakircay University, Faculty of Medicine, Izmir, Turkey
| | - Abdulhalim Aysel
- Department of Otolaryngology - Head and Neck Surgery, Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Elif Sari
- Department of Otolaryngology - Head and Neck Surgery, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey
| | - Ferda Erol
- Department of Otolaryngology - Head and Neck Surgery, Bozyaka Education and Research Hospital, Izmir, Turkey
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13
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Longobardi Y, Savoia V, Parrilla C, Marchese MR, Morra L, Mari G, Degni E, D’Alatri L. Pre-operative speech-language pathology counselling in patients undergoing total laryngectomy: A pilot randomized clinical trial. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01932-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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The Effect of Photographic Visual Aids in Preoperative Patient Counseling in Oculoplastic Surgery. Ophthalmic Plast Reconstr Surg 2021; 37:S70-S75. [PMID: 32976331 DOI: 10.1097/iop.0000000000001817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the effect of visual supplementation and its mode of delivery in preoperative counseling of patients undergoing oculoplastic surgery. METHODS A prospective randomized controlled trial of consecutive patients undergoing oculoplastic eyebrow and eyelid surgery was conducted. Patients were randomized to an "oral only" group receiving routine preoperative oral counseling or an "oral and visual" group receiving identical counseling visually supplemented with photographs demonstrating common postoperative physical findings. Patients in the "oral and visual" group were further randomized to receive education from the medical team in person versus prerecorded video. Patient emotions and expectations regarding postoperative healing were assessed preoperatively and at 1 week and 2 months postoperatively. RESULTS 103 patients were included: 32 received in-person oral education, 33 received in-person oral education with photographs, and 38 received education with photographs via video. There were no significant differences in demographics or preoperative patient fear, anxiety, or preparedness. The "oral and visual" group expected more severe postsurgical discomfort and physical findings at postoperative day 1 and week 1. There were no significant differences between groups in surgery signup, cancellation, or triage call rates; patient expectations of postoperative months 2 and 4; or in anxiety, preparedness, or satisfaction. CONCLUSIONS Visual supplementation in preoperative counseling increases patient expectations of postoperative physical findings without escalating fear or anxiety, and has no significant impact on patient emotions, triage call rates, and satisfaction throughout their surgical experience. Preoperative education via video is perceived by patients to be equivalent to counseling in person by the surgeon.
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15
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Feiner M, Keszte J, Meyer A, Kulnik ST, Maasz M, Lothaller H, Fuchs M, Hormes K, Oeken J, Vogel HJ, Koscielny S, Papst F, Singer S. Effects of Finding the Speech-Language Pathologist Likeable on Postlaryngectomy Speech Intelligibility Outcomes. Folia Phoniatr Logop 2021; 73:577-585. [PMID: 33626535 DOI: 10.1159/000513928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 12/18/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Speech-language pathologists (SLPs) work with patients after total laryngectomy (TL) to regain verbal communication. The influence of the quality of the therapeutic relationship on the success of TL voice rehabilitation in terms of speech intelligibility is not known. Finding each other likeable is an important factor in establishing and maintaining interpersonal relationships in everyday life. The fit of therapist and client is relevant to the therapeutic relationship. The purpose of this study therefore was to assess the association between the degree of SLPs' likeability ratings and postlaryngectomy speech intelligibility. METHODS In a multicentre prospective cohort study, participants rated their SLPs' likeability after finishing TL rehabilitation. Speech intelligibility was measured objectively with the Post-Laryngectomy Telephone Intelligibility Test and subjectively with the Questionnaire for Adjustment after Laryngectomy. The association of SLPs' likeability with speech intelligibility was analysed using hierarchical logistic regression, expressed with odds ratios (OR) with corresponding 95% confidence intervals (CI). RESULTS Altogether 124 patients from 13 institutions participated. The degree of finding the SLP likeable was not significantly associated with objective speech intelligibility (OR 1.30; 95% CI 0.78-2.18; p = 0.32) or subjective speech intelligibility (OR 1.01; 95% CI 0.60-1.72; p = 0.96) after controlling for age, sex and education factors. DISCUSSION/CONCLUSION In this patient cohort, there was no evidence for an association between ratings of SLPs' likeability and speech intelligibility outcomes after rehabilitation. Future studies could consider the use of alternative instruments for measuring likeability.
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Affiliation(s)
- Marlies Feiner
- Speech-Language Pathology Services, Department of ENT, University Hospital of Graz, Graz, Austria,
| | | | - Alexandra Meyer
- Department of Hematology and Hemato-Oncology and Psycho-Oncology, MVZ Delitzsch, Delitzsch, Germany
| | - Stefan T Kulnik
- Faculty of Health, Social Care and Education, Kingston University and St. George's University of London, London, United Kingdom.,Department of Health, University of Applied Sciences FH Campus Vienna, Vienna, Austria
| | - Martin Maasz
- Department of Health, University of Applied Sciences FH Campus Vienna, Vienna, Austria
| | | | - Michael Fuchs
- Section of Phoniatrics and Audiology, Department of Otorhinolaryngology, University of Leipzig, Leipzig, Germany
| | - Karl Hormes
- Rehabilitation Clinic Sonnenbergklinik, Bad Sooden-Allendorf, Germany
| | - Jens Oeken
- Department of Otorhinolaryngology, Community Hospital Chemnitz, Chemnitz, Germany
| | - Hans-Joachim Vogel
- Department of Otorhinolaryngology, Sana-Klinikum Remscheid, Remscheid, Germany
| | - Sven Koscielny
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Friedemann Papst
- Department of Otorhinolaryngology, Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany.,University Cancer Center, Mainz, Germany
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16
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Noel CW, Forner D, Wu V, Enepekides D, Irish JC, Husain Z, Chan KKW, Hallet J, Coburn N, Eskander A. Predictors of surgical readmission, unplanned hospitalization and emergency department use in head and neck oncology: A systematic review. Oral Oncol 2020; 111:105039. [PMID: 33141060 DOI: 10.1016/j.oraloncology.2020.105039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/18/2020] [Accepted: 10/04/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To identify predictors of unplanned hospitalization and emergency department (ED) use among head and neck oncology patients. METHODS Peer reviewed publications were identified through a systematic search of MEDLINE, Embase and Cochrane CENTRAL. Studies describing a cohort of HNC patients that detailed predictors of unplanned hospitalization or ED use in risk-adjusted models were eligible for inclusion. The methodologic quality of included studies was assessed using the Quality In Prognostic Studies (QUIPS) tool and an adapted version of the GRADE framework. RESULTS Of the 932 articles identified, 39 studies met our inclusion criteria with 31/39 describing predictors of surgical readmission and 10/39 describing predictors of ED use or unplanned hospitalization during radiation/chemoradiation treatment. Risk factors were classified into either 'patient-related', 'cancer severity' or 'process' factors. In the subset of studies looking at readmission following surgery wound complications (10/14 studies), presence of comorbidity (16/28 studies), low socioeconomic status (8/17 studies), cancer stage (9/14 studies), and prolonged hospital stay (7/18 studies) were the variables most frequently associated with readmission on multivariable analysis. Presence of comorbidity (6/10) and chemotherapy use (4/10) were more frequently associated with ED use and unplanned hospitalization. CONCLUSIONS Several consistent predictors have been identified across a variety of studies. This work is a critical first step towards the development of readmission and ED prediction models. It also enables meaningful comparison of hospital readmission rates with risk adjustment in HNC patients.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Natalie Coburn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
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17
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Systematic review of incidence, risk factors, prevention and treatment of post-laryngectomy hypoparathyroidism. Eur Arch Otorhinolaryngol 2020; 278:1337-1344. [PMID: 32700234 PMCID: PMC8058002 DOI: 10.1007/s00405-020-06213-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Abstract
Purpose Post-laryngectomy hypoparathyroidism is associated with significant short- and long-term morbidities. This systematic review aimed to determine incidence, risk factors, prevention and treatment of post-laryngectomy hypoparathyroidism. Methods Medline, EMBASE and the Cochrane library were searched for relevant articles on hypocalcaemia and/or hypoparathyroidism after laryngectomy or pharyngectomy. Two authors independently screened titles and abstracts from the search. Data from individual studies were collated and presented (without meta-analysis). Quality assessment of included studies was undertaken. The review protocol was registered in the PROSPERO database (CRD42019133879). Results Twenty-three observational studies were included. The rates of transient and long-term hypoparathyroidism following laryngectomy with concomitant hemi- or total thyroidectomy ranged from 5.6 to 57.1% (n = 13 studies) and 0 to 12.8% (n = 5 studies), respectively. Higher transient (62.1–100%) and long-term (12.5–91.6%) rates were reported in patients who had concomitant oesophagectomy and total thyroidectomy (n = 4 studies). Other risk factors included bilateral selective lateral neck dissection, salvage laryngectomy and total pharyngectomy. There is a lack of data on prevention and management. Conclusion Hypoparathyroidism occurs in a significant number of patients after laryngectomy. Patients who underwent laryngectomy with concomitant hemithyroidectomy may still develop hypoparathyroidism. Research on prevention and treatment is lacking and needs to be encouraged.
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18
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Vimawala S, Topf MC, Savard C, Zhan T, Keane W, Luginbuhl A, Goldman R, Cognetti DM, Curry JM. Risk factors for unplanned readmission in total laryngectomy patients. Laryngoscope 2019; 130:1725-1732. [DOI: 10.1002/lary.28255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Swar Vimawala
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | | | - Corey Savard
- Sidney Kimmel Medical CollegeThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - Tingting Zhan
- Division of Biostatistics, Department of Pharmacology and Experimental TherapeuticsThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - William Keane
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - Adam Luginbuhl
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - Richard Goldman
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - David M. Cognetti
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - Joseph M. Curry
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
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19
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Gill A, Farwell DG, Moore MG. Nutrition and Perioperative Care for the Patient with Head and Neck Cancer. Oral Maxillofac Surg Clin North Am 2018; 30:411-420. [DOI: 10.1016/j.coms.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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20
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Panwar A, Wang F, Lindau R, Militsakh O, Coughlin A, Smith R, Sayles H, Lydiatt D, Lydiatt W. Prediction of Discharge Destination following Laryngectomy. Otolaryngol Head Neck Surg 2018; 159:1006-1011. [PMID: 30126321 DOI: 10.1177/0194599818792211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective To identify factors that may predict discharge to intermediate-care facilities following total laryngectomy and may promote earlier discharge planning and optimize resource utilization. Study Design Retrospective review of large national data set. Setting Academic and nonacademic health care facilities in United States, contributing deidentified, risk-adjusted clinical data to the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP). Subjects and Methods Retrospective evaluation of the NSQIP database (2011-2014) identified 487 patients who underwent total laryngectomy without free tissue transfer. Risk of discharge to intermediate-care facilities was evaluated. Role of preoperative and postoperative factors and their association with discharge disposition were assessed using multivariable regression analysis. Results Compared to reference groups, advanced age (61-70 years: odds ratio [OR], 3.16; 95% confidence interval [CI], 1.12-8.89; >70 years: OR, 3.77; 95% CI, 1.33-10.65), baseline functional dependence (OR, 5.61; 95% CI, 2.62-12.02), cardiac failure (OR, 3.80; 95% CI, 1.08-13.42), and steroid dependence (OR, 3.30; 95% CI, 1.36-8.0) independently predicted discharge to intermediate-care facilities. Conclusion Patients with advanced age, functional dependence, cardiac failure, and steroid dependence may benefit from preemptive counseling and discharge planning in anticipation of postlaryngectomy discharge to intermediate-care facilities.
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Affiliation(s)
- Aru Panwar
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, Nebraska, USA
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Fangfang Wang
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Robert Lindau
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, Nebraska, USA
| | - Oleg Militsakh
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, Nebraska, USA
| | - Andrew Coughlin
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, Nebraska, USA
| | - Russell Smith
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, Nebraska, USA
| | - Harlan Sayles
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Daniel Lydiatt
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, Nebraska, USA
| | - William Lydiatt
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, Nebraska, USA
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21
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Krouse JH. Highlights from the Current Issue. Otolaryngol Head Neck Surg 2018; 156:201-202. [PMID: 28145835 DOI: 10.1177/0194599816685303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- John H Krouse
- 1 Department of Otolaryngology/Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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22
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Zhang J, Miller CJ, O'Malley V, Etzkorn JR, Shin TM, Sobanko JF. Patient quality of life fluctuates before and after Mohs micrographic surgery: A longitudinal assessment of the patient experience. J Am Acad Dermatol 2018. [PMID: 29518455 DOI: 10.1016/j.jaad.2018.02.065] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Changes in patient perceptions of quality of life (QOL) after Mohs micrographic surgery (MMS) may benefit from different counseling or treatment. OBJECTIVE To measure QOL before and after MMS and to identify risk factors associated with impaired QOL. METHODS Prospective observational study of 727 patients with skin cancer who self-reported QOL via the Skin Cancer Index immediately before and at 1 to 2 weeks and 3 months after MMS. RESULTS QOL fluctuated after MMS. At 1 to 2 weeks after surgery, overall QOL remained unchanged compared with before MMS. Patients reported reduced anxiety about skin cancer but had increased distress about social interactions and physical appearance. At 3 months after surgery, patients reported an overall improvement in QOL compared with before MMS (P = .0007). Age younger than 65 years (P = .0001), female sex (P = .0001), and tobacco use (P = .03) were associated with lower QOL scores at all assessment points. LIMITATIONS Single-site observational study. Significant loss to follow-up at both time points after MMS. CONCLUSION Patients with skin cancer had persistent concerns about social interactions and physical appearance 1 to 2 weeks after MMS, but all aspects of their QOL improved by 3 months after surgery. Patients who underwent MMS that were younger than 65 years, were female, or smoked were at increased risk for longitudinally impaired QOL.
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Affiliation(s)
- Junqian Zhang
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Division of Dermatologic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victoria O'Malley
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Division of Dermatologic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Division of Dermatologic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Division of Dermatologic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
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23
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Graboyes EM, Schrank TP, Worley ML, Momin SR, Day TA, Huang AT. Thirty-day readmission in patients undergoing head and neck microvascular reconstruction. Head Neck 2018; 40:1366-1374. [DOI: 10.1002/hed.25107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/06/2017] [Accepted: 01/19/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Evan M. Graboyes
- Department of Otolaryngology - Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina
- Hollings Cancer Center; Medical University of South Carolina; Charleston South Carolina
| | - Travis P. Schrank
- Department of Otolaryngology - Head and Neck Surgery; University of North Carolina; Chapel Hill North Carolina
| | - Mitchell L. Worley
- Department of Otolaryngology - Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina
| | - Suhael R. Momin
- Department of Otolaryngology-Head and Neck Surgery; Henry Fold Health System; Detroit Michigan
| | - Terry A. Day
- Department of Otolaryngology - Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina
| | - Andrew T. Huang
- Department of Otolaryngology - Head and Neck Surgery; Baylor College of Medicine; Houston Texas
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Ferrandino R, Garneau J, Roof S, Pacheco C, Poojary P, Saha A, Chauhan K, Miles B. The national landscape of unplanned 30-day readmissions after total laryngectomy. Laryngoscope 2017; 128:1842-1850. [PMID: 29152760 DOI: 10.1002/lary.27012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/11/2017] [Accepted: 10/20/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Examine rates of readmission after total laryngectomy and determine primary etiologies, timing, and risk factors for unplanned readmission. STUDY DESIGN Retrospective cohort study. METHODS The Nationwide Readmissions Database was queried for patients who underwent total laryngectomy between January 2013 and November 2013. Patient-, procedure-, admission-, and institution-level characteristics were compared for patients with and without unplanned 30-day readmission. Outcomes of interest included rates, etiology, and timing of readmission. Multivariate logistic regression was used to identify predictors of 30-day readmission. RESULTS There were 2,931 total laryngectomies performed in 2013 with an unplanned readmission rate of 17.5%. Postoperative fistula accounted for 13.7% of readmissions. The odds of readmission were elevated for patients undergoing concurrent procedures, including primary tracheoesophageal fistulization (adjusted odds ratio [aOR]: 2.44, 95% confidence interval [CI]: 1.15-5.18, P = .02) and/or pedicle graft or flap procedures (aOR: 1.73, 95% CI: 1.13-2.66, P = .01). Additionally, patients with comorbid coagulopathy (aOR: 3.04, 95% CI: 1.13-8.22, P = .03), liver disease (aOR: 2.48, 95% CI: 1.08-5.71, P = .03), and valvular heart disease (aOR: 3.18, 95% CI: 1.20-8.41, P = .02) had increased risk for unplanned 30-day readmission. Private insurance and longer lengths of stay were associated with decreased odds of readmission. CONCLUSIONS Nearly one-fifth of total laryngectomy patients are readmitted to the hospital within 30 days of discharge. Risk factors identified in this nationally representative cohort should be carefully considered during the postoperative period to reduce preventable readmissions after total laryngectomy. LEVEL OF EVIDENCE 2c Laryngoscope, 1842-1850, 2018.
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Affiliation(s)
- Rocco Ferrandino
- Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Jonathan Garneau
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Scott Roof
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Caitlin Pacheco
- Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Priti Poojary
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Aparna Saha
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Kinsuk Chauhan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Brett Miles
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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Head & neck reconstruction: Predictors of readmission. Oral Oncol 2017; 74:159-162. [DOI: 10.1016/j.oraloncology.2017.06.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/08/2017] [Accepted: 06/20/2017] [Indexed: 11/17/2022]
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Osborn HA, Rathi VK, Tjoa T, Goyal N, Yarlagadda BB, Rich DL, Emerick KS, Lin DT, Deschler DG, Durand ML. Risk factors for thirty-day readmission following flap reconstruction of oncologic defects of the head and neck. Laryngoscope 2017; 128:343-349. [DOI: 10.1002/lary.26726] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/02/2017] [Accepted: 05/08/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Heather A. Osborn
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Vinay K. Rathi
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Tjoson Tjoa
- Department of Otolaryngology; University of California; Irvine California
| | - Neerav Goyal
- Penn State Milton S. Hershey Medical Center, Division of Otolaryngology Head and Neck Surgery; Hershey Pennsylvania
| | - Bharat B. Yarlagadda
- Department of Otolaryngology; Lahey Hospital and Medical Center; Burlington Massachusetts
| | - Debbie L. Rich
- Department of Nursing; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Kevin S. Emerick
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Derrick T. Lin
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Daniel G. Deschler
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Marlene L. Durand
- Department of Medicine; Infectious Disease Unit, Massachusetts General Hospital and Infectious Disease Service, Massachusetts Eye and Ear Infirmary; Boston Massachusetts
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Eskander A, Mifsud M, Irish J, Gullane P, Gilbert R, Brown D, de Almeida JR, Urbach DR, Goldstein DP. Overview of surgery for laryngeal and hypopharyngeal cancer in Ontario, 2003-2010. Head Neck 2017; 39:1559-1567. [PMID: 28593742 DOI: 10.1002/hed.24787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 01/24/2017] [Accepted: 02/14/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The primary purpose of this study was to describe variations in incidence rates, resections rates, and types of surgical resection for patients diagnosed with laryngeal and hypopharyngeal cancers in Ontario. METHODS All laryngeal and hypopharyngeal cancer cases in Ontario (2003-2010) were identified from the Ontario Cancer Registry (n = 3034). Variations in incidence rates, resection rates, and type of surgical resection were compared by sex, age group, neighborhood income, community population, health region, and physician specialty. RESULTS Incidence rates per 100 000 vary significantly by sex, age, neighborhood income, and community size. Women, the elderly (75+ years), those in the higher income quintiles, and those living in larger communities were significantly less likely to receive a laryngectomy procedure. CONCLUSIONS Laryngeal and hypopharyngeal cancer incidence rates vary by sex, age, neighborhood income, community size, and health region. Resection rates vary by age, sex, and health region. These disparities warrant further evaluation to improve the quality of delivered care in Ontario.
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Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Mifsud
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Irish
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Patrick Gullane
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Dale Brown
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David R Urbach
- Division of General Surgery, Department of General Surgery and Surgical Oncology, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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28
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Liu JC. Commentary on Shenson et al, "Effect of Preoperative Counseling on Hospital Length of Stay and Readmissions after Total Laryngectomy". Otolaryngol Head Neck Surg 2017; 156:203-204. [PMID: 28145831 DOI: 10.1177/0194599816680357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jeffrey C Liu
- 1 Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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