Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P264

P264
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.
Conclusions: Patient education materials can be provided at
the recommended reading level of sixth grade or lower. This
study highlights the minimal changes required to improve the
reading level of postoperative education materials to make
information more understandable to all patients.
National Survey in England for Surgical Site
Infections in Head and Neck Surgery
Annakan Victor Navaratnam, MBBS, FRCS (Presenter);
Cherrie Ho; Tim Briggs; Andrew H. Marshall, FRSC, MBBS
Objectives: Surgical site infections (SSIs) in head and neck
surgery can have devastating consequences because of the
proximity of vital structures including the airway and major
cervical vessels. However, not all units performing this surgery have processes in place to audit SSI activity. The Getting
It Right First Time program led a national survey to assess SSI
rates across 13 surgical specialties including ear, nose, and
throat (ENT) head and neck surgery.
Methods: The survey was conducted prospectively between
the May 1, 2019, and October 31, 2019. Head and neck resections (H&N) and thyroid surgery were included. Data were
collected on all SSIs and their management during this time
period. A total of 27 National Health Service ENT departments registered.
Results: From the registered departments, 18 units performed H&N and thyroid surgery and 9 units performed thyroid surgery only. In total, the SSI rate was 0.7% in 2217 H&N
(excluding thyroid) cases with individual units ranging from
0% to 3.5%, and the SSI rate was 1.1% in 1486 thyroid surgery cases with individual units ranging from 0% to 12.2%.
Ten units had existing SSI audit protocols in place, and
21 units had local antibiotic prophylaxis guidelines.
Conclusions: Head and neck surgery units should have
robust systems in place to identify SSIs in their departments
and clear guidance regarding management. This survey highlights the variation in SSI rates, especially in thyroid surgery,
and places an emphasis on improvement to advance patient
safety.

PSQI

Otolaryngologic Complications Related
to the Anterior Cervical Approach:
A Literature Review
Stephanie Johng (Presenter); Alexander X. Tai, MD;
Faheem A. Sandhu, MD, PhD; Earl H. Harley, MD
Objectives: The anterior cervical approach (ACA) is commonly used by spinal surgeons to access the cervical spine. It
is fast, well tolerated, and can be used for simple decompressions to large spinal corrections. Given the complex anatomy,
as well as the need to dissect around and retract critical structures in the neck, complications can occasionally arise that fall
within the domain of otolaryngologists.
Methods: Review of the literature.
Results: To the best of our knowledge, no study has comprehensively reviewed all potential otolaryngologic complications that can arise with the ACA. Although complications

arising secondary to the ACA are rare, when they do occur,
they can require the expertise of otolaryngologists. Examples
of such complications include esophageal/pharyngeal perforations, hypopharyngeal diverticuli, airway compromise
due to hematomas, dysphonia caused by either recurrent or
superior laryngeal nerve injuries, thoracic duct injury, and
Horner syndrome. Other factors that should be kept under
consideration include surgeons' preferences on approach
laterality, manipulation of the endotracheal tube during the
procedure, and difficulties with revision or deformity
corrections.
Conclusions: Since its introduction in the 1950s, the ACA
has remained one of the most frequently used approaches to
access the cervical spine. Thus, it is essential that both spinal
surgeons and otolaryngologists be aware of the potential complications that can arise during this approach.
Perceptions of Safety Climate and Fatigue
Related to ACGME Residency Duty-Hour
Restrictions in Otolaryngology Residents
Michele M. Carr, MD, DDS, PhD (Presenter); Jonathan
Friedel, PhD; Daniel C. O'Brien, MD; Anne Foreman, PhD;
Oliver Wirth, PhD
Objectives: To compare otolaryngology residents' perceptions of safety climate with respect to duty-hour compliance
and self-perceived fatigue.
Methods: A sample of otolaryngology residents were surveyed electronically in 2019. A total of 41 programs were
included. The survey included demographic details, on-call
descriptors, an 18-point Safety Climate Survey (SCS) modified to measure the respondent's perceptions of their program's
attitudes and practices around resident duty-hour compliance,
and the 33-point Chalder Fatigue Questionnaire (CFQ).
Pearson correlation coefficients with P < .05 were used.
Results: Overall, 205 of 397 surveyed (52%) responded;
67% were currently taking first call and 59% had protected
time off after call. The mean modified SCS score was 11.29 of
18 (95% CI, 10.76-11.81). Respondents were most likely to
disagree with the item, "Residents are told when they are at
risk of working beyond ACGME (Accreditation Council for
Graduate Medical Education) duty-hour restrictions," for
which 100 (49%) disagreed or strongly disagreed. The mean
CFQ score was 15.99 of 33 (95% CI, 15.17-16.81). As the
modified SCS score improved, CFQ scores decreased, indicating an inverse relationship between duty-hour safety climate and fatigue. Respondents able to identify who decides if
postcall days are taken off (either the resident themselves, the
chief resident, attending faculty, or program director) had
higher SCS scores, whereas respondents who were unsure
who decides had lower SCS scores. Residents further along in
their training reported less fatigue and better perceived safety
climate.
Conclusions: An inverse relationship between fatigue scale
scores and modified SCS scores suggests that perceived
fatigue among residents is lower in programs in which

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

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