Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P258

P258
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
Distress Screening as a Predictor for
Perioperative Measures and Postoperative
Outcomes in Head and Neck Cancer
Patients
Frances Mei Hardin, MD (Presenter); Patrick Tassone, MD
Objectives: An estimated 20% to 60% of head and neck cancer patients have reported distress at some point during the
evaluation and management of their disease. The critical role
of psychosocial care in the treatment of cancer patients, and
the importance of addressing their distress, has been widely
recognized. The National Comprehensive Cancer Network
provides a distress thermometer (DT) screening tool required
at initial visits with new cancer patients, and this provides
valuable information regarding patient distress levels, in particular, high-risk factors for distress as highly prevalent in the
head and neck population, including smoking and alcohol use
disorders, and functional losses that affect swallow or speech
or that cause disfigurement. The purpose of this study is to
evaluate for a relationship between distress scores and several
perioperative and postoperative metrics.
Methods: This is a retrospective study of the DT results in
the head and neck cancer patient population at a single institution between 2018 and 2020.
Results: Data collection and analysis are ongoing. The primary outcomes evaluated are distress scores, stratified by subsite and staging, as well as the time from initial clinic visit to
definitive surgical management. Additional metrics include
the number of missed appointments, length of postoperative
hospital stay, and time from primary surgical treatment to
adjuvant chemoradiation therapy (CRT) start date.
Conclusions: The results will be used to implement a streamlined protocol for Ellis Fischel Cancer Center (eg, patients
above a certain DT cutoff will be fast-tracked into psychiatric
support). The results will also be used as part of a quality
improvement initiative because it may identify areas for
improvement with regard to time to surgery or time to adjuvant CRT after surgery.

PSQI

Does Graduation Year Impact Opioid
Prescribing in Ambulatory Otolaryngology?
Geoffrey C. Casazza, MD (Presenter); Alexander L.
Ramirez, MD; Paul R. Krakovitz, MD; Jeremy D. Meier, MD
Objectives: In 2001, the Joint Commission established pain as
the fifth vital sign. How this is reflected in ambulatory otolaryngology surgery has yet to be determined. This study evaluated
how the timing of surgeon training affects opioid prescribing.
Methods: Opioid prescribing information was collected for
all patients undergoing ambulatory otolaryngology surgery
within a multihospital system from March 2017 to August
2018. Postoperative pain control was collected from patient
surveys. The 3 most commonly performed single procedures
(septoplasty, thyroidectomy, and adenotonsillectomy) were
aggregated. Surgeons with fewer than 3 procedures were
excluded. Surgeons were divided by residency graduation year

(pre-2001 vs 2001 to current). Narcotic amounts were converted to oral morphine equivalents (OMEs) for comparison.
Results: The cohort included surgeons graduating otolaryngology residency between 1980 and 2015. There were 24 surgeons in the septoplasty, 23 in the tonsillectomy, and 11 in the
thyroidectomy groups. There was no significant difference in
mean OME prescribed for septoplasty (238.5 vs 216.4; P =
.6), adenotonsillectomy (409 vs 431.5; P = .5), or thyroidectomy (192.3 vs 169; P = .86) between pre-2001 and 2001 to
current groups, respectively. There was also no significant difference in mean patient-reported pain control between septoplasty (1.68 vs 1.75; P = .66), adenotonsillectomy (2.16 vs
2.26; P = .6), and thyroidectomy (1.85 vs 1.43; P = .1) for
patients treated by surgeons in pre-2001 and 2001 to current
groups, respectively.
Conclusions: No difference in opioid prescribing was found
based on the time of training graduation. Further research is
needed to define factors associated with physician preference
for opioid prescribing patterns in otolaryngology.
The Effect of Smoking on Short-term
Complications Following Microvascular Free
Tissue Transfer
Ishwarya Shradha Mamidi (Presenter); Ashley Marie
Lloyd, MD; Ryan Lee; Arjun S. Joshi, MD; Joseph F.
Goodman, MD; Punam G. Thakkar, MD
Objectives: Microvascular free flaps have become the mainstay for reconstruction after head and neck tumor extirpation.
Advances in microsurgical technique and perioperative management have decreased the morbidity of free flap reconstruction while allowing for esthetic and functional rehabilitation.
Despite a high success rate, studies show that 5% to 25% of
free flaps will have a complication requiring re-exploration.
We aim to examine the impact of smoking on 30-day morbidity and mortality following head and neck free tissue
transfer.
Methods: The American College of Surgeons National
Surgical Quality Improvement Program (ACS NSQIP) database was queried to identify patients who underwent microvascular reconstruction procedures between 2005 and 2016,
performed exclusively by otolaryngologists. Patients were
divided into 2 cohorts: current smokers and nonsmokers and
were propensity matched in a randomized 2:1 manner to compare 30-day complication rates. Multivariate logistic regression models were also utilized to assess smoking status as an
independent risk factor for complications.
Results: Overall, 2213 patients were isolated. In comparison
to the propensity-matched control cohort (n = 1175), the
smokers (n = 609) demonstrated significantly higher rates of
readmission (P = .004), reoperation (P = .036), extended
length of stay (LOS; P = .008), and wound dehiscence (P =
.001). Multivariate logistic regression models demonstrated
smoking to be a significant independent risk factor for
extended LOS (odds ratio [OR], 1.787, P = .032) and reoperation (OR, 1.332, P = .022).

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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