Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P73

Oral Presentations	

Outpatient Versus Inpatient Parotidectomy:
A Systematic Review
Daniel Bestourous (Presenter); Daniel A. Benito, MD; Luke
Pasick; Christopher D. Badger; Punam G. Thakkar, MD;
Joseph F. Goodman, MD; Arjun S. Joshi, MD
Objectives: Parotidectomy has traditionally been regarded
as an inpatient procedure. Recent literature suggests that outpatient head and neck surgery is just as safe as inpatient surgery, may decrease costs, and improve patient satisfaction.
Methods: A systematic literature search was performed
using MEDLINE, Embase, CINAHL, and Cochrane Library
from January 1970 to December 1, 2019, following Preferred
Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines. Inclusion criteria included studies
written in English with adult patients who underwent parotidectomy on either an outpatient or inpatient basis. Perioperative
outcomes and complications were collected.
Results: A total of 1302 search results were screened for
studies comparing outcomes between inpatient and outpatient
cohorts. Twenty-seven studies met criteria for full text review,
yielding 4 retrospective studies involving 911 patients for
qualitative analysis. Of the patients, 70.5% (n = 642) underwent inpatient parotidectomies and 29.5% (n = 269) underwent outpatient parotidectomy. Patients who underwent
outpatient parotidectomies were found to have a lower incidence of minor complications, including hematoma (1.59% vs
4.30%, P = .039852), seroma or sialocele formation (2.43% vs
5.15%, P = 0.101031), and readmission and/or reoperation
(0% vs 3.70%, P = .023875). No significant difference was
observed between rates of drain placement (91.0% outpatient
vs 91.24% inpatient, P = .919083).
Conclusions: Preliminary results suggest that patients who
undergo parotidectomies in the outpatient setting may be at
decreased risk of developing complications when compared
with patients who undergo inpatient parotidectomies. Major
limitations to this study include the risk of bias and the heterogeneity of reporting outcomes.
Parascapular Free Flaps as a Reliable Method
for Complex Head and Neck Surgical
Defects Requiring Free Tissue Transfer
Meade C. Edmunds (Presenter); J. Dale Browne, MD;
Sydney Thomas; Hafiz Patwa, MD
Objectives: This study aimed to define perioperative factors,
surgical outcomes, and clinical outcomes for patients who

have undergone head and neck cancer resection and parascapular fasciocutaneous free flap reconstruction.
Methods: All patients who underwent cancer resection
involving the head and neck and parascapular fasciocutaneous
free flap reconstruction at a single tertiary care center between
September 2012 and December 2018 were included (n = 78).
Variables reviewed were patient age, tobacco use, previous
treatments received, cancer type, surgical defect size, followup duration, and postoperative complications, including flap
congestion, dehiscence, necrosis, hematoma, seroma, and frequency of need for flap revision within the operative setting.
Results: Seventy-eight patients with cancer involving the
head and neck who underwent reconstruction with use of a
parascapular fasciocutaneous free flap were included in the
study. Thirty-eight patients received radiation, chemotherapy,
or a combination prior to surgery (49%). Primary malignancy
locations included cutaneous (21%), oral cavity (32%), oropharynx (5%), nasopharynx (3%), sinus (17%), parotid (4%),
infratemporal fossa (4%), hypopharynx (5%), and larynx
(8%). Flap complications occurred in 27 patients (35%),
including dehiscence (16), fistula (7), hematoma (1), abscess
(1), venous congestion (4), necrosis (8), and loss of viability
(4). Donor site complications included wound dehiscence (5)
and infection (1). The overall success of the reconstruction
was 95%.
Conclusions: Parascapular fasciocutaneous free flaps can be
a resilient donor site for soft tissue reconstruction of head and
neck cancer surgical defects even for patients undergoing salvage surgery.
Perineural Invasion in Oral Squamous Cell
Carcinoma and Its Ability to Predict Patient
Outcomes
Andrew B. Davis, MD (Presenter); Renee Eigsti, MD;
Kathryn Marcus; Anand Rajan
Objectives: Perineural invasion (PNI) is thought to predict
negative outcomes in oral squamous cell carcinoma (OSCC)
patients. Reporting of PNI is not standardized, and no consensus exists on whether size or number of involved nerves is
important. We sought to quantify the impact of PNI burden
and nerve size on surgically treated OSCC.
Methods: We identified a cohort of OSCC patients (n = 274)
from 2006 to 2018 who underwent primary surgical resection.
Primary tumor resections were scanned digitally. All nerves
were annotated on the slides, irrespective of size, and nerves
with PNI were measured (µm). Multiple variables were collected, and disease-specific survival (DSS) and progressionfree survival (PFS) were calculated.
Results: PNI was detected in 146 cases (53%). PNI was not
associated with local recurrence (P = .256) but was significant
for distant metastases (P = .009). PNI was associated with
higher T stage (T3/T4 vs T1 vs T2), higher nodal stage, and
presence of nodal involvement (P < .05). PNI showed a significant association with worse DSS and overall survival. On
univariate analysis, nerve burden and nerve diameter showed
a significant association with worse outcomes, but PNI status

Head and Neck

[1.25-4.80], P = .009). Patients with a history of PE specifically were found to have significantly increased risk for flap
failure (7.70 [1.77-33.52], P = .007). Prior VTE was not independently associated with an increased risk for medical complications or readmission.
Conclusions: Patients with a history of VTE may be at
increased risk for free flap compromise secondary to postoperative pedicle thrombosis. This risk should be considered in
preoperative workup and postoperative monitoring.

P73
Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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