Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P76

Head and Neck

P76		
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.
Demographics, comorbidities, and surgical variables were
Conclusions: Preemptive use of ABDMF may help to preretrieved. Given that the abbreviated LOS aims to discharge
vent formation of PCF by reinforcing the posteroinferior
all patients on postoperative day (POD) 5, this was the end
boundary of parapharyngeal space in patients undergoing
point for statistical analysis. Readmission and discharge by
TORRT with simultaneous ND preserving level 1, without
POD 7 were secondary outcomes.
any significant morbidity. SCMMF provides an alternative
Results: There were 272 males (63%) with a median age of
when level 1 is included in ND.
62. Most common defect location was oral cavity; flaps utilized were anterolateral thigh flap (n = 173, 40%), radial free
Preoperative Risk Factor Impact on
forearm (n = 138, 32%), and fibula (n = 90, 21%). The mean
Posthospitalization Care Needs After Free
LOS was 6.5 days (SD = 3.4); discharge on POD 5 was
Flap Reconstruction of the Head and Neck
achieved in 54% (119), and by POD 7 in 84%. The flap sucMichael H. Freeman, MD (Presenter); Justin R. Shinn, MD;
cess rate was 97.3%. Readmission rate within 30 days for any
Jaclyn Lee; Douglas Totten; Nicole Kloosterman; Carey
reason was 17.4%. Age older than 75 (P < .001), need for secBurton Wood, MD; Sarah L. Rohde, MD
ond line antibiotics (P = .045), history of cerebrovascular
Objectives: To determine the preoperative risk factors most
accident (P = .02), arrhythmia (P = 0.028), peripheral vascular
predictive
of posthospitalization care needs after free flap
disease (P = .002), and preoperative gastrostomy tube (P =
reconstruction
of the head and neck.
.001) were associated with a longer LOS. Analysis for LOS at
Methods:
A
retrospective
cohort study was conducted with
7 days postoperative revealed the same predictors, with the
1009
patients
who
underwent
tumor resection and free flap
addition of diabetes (P = .001).
reconstruction
of
the
head
and
neck
at a tertiary referral center
Conclusions: A clinical pathway for abbreviated LOS in
from
2002
to
2019.
head and neck microvascular reconstruction is effective in
Results: Of 1009 patients (65.7% male; mean age of 61.4,
achieving discharge in POD 5 in most patients. However,
SD
14.0), 161 (15.6%) were discharged to a skilled nursing
patients older than 75, those with enteral tube feeding, or with
facility
(SNF) or inpatient rehabilitation (IPR) center, and
extensive cardiovascular history may require additional intermedian
length
of stay was 7 days. In multiple linear regression
ventions or an alternative perioperative pathway.
analysis, Charlson Comorbidity Index (CCI) (P = 0.0063),
American Society of Anesthesiologists (ASA) classification
Preemptive Utilization of the Anterior Belly
(P = .0176), and inability to tolerate oral diet (P = .0056) were
of the Digastric Muscle Flap in Transoral
all statistically significantly related to increased length of stay
Robotic Radical Tonsillectomy
(LOS), whereas age, body mass index (BMI), sex, modified
Olivia A. Daigle, MD (Presenter); Mauricio A. Moreno-Vera, MD;
frailty index (mFI-11), a history of prior radiation or chemoDeanne King, MD; Santiago Gonzalez; Emre A. Vural, MD
therapy, oral intake status, and home oxygen use were not.
Objectives: The primary end point of the study was to assess
Multiple logistic regression analysis demonstrated that age
the rate of pharyngocutaneous fistula (PCF) formation when an
(odds ratio [OR] = 1.0818; CI, 1.056-1.108) and BMI of less
anterior belly of the digastric muscle flap (ABDMF) is used
than 19 (OR = 2.141; CI, 1.159-3.807) were the only variables
during transoral robotic radical tonsillectomy (TORRT) with
statistically significantly related to posthospital placement in
concomitant neck dissection (ND) vs when no reconstruction
an SNF or IPR. Subanalysis of CCI/mFI-11 associated com-
is done. Our objective was to prove that this method is a reaorbidities showed no significant relationships to SNF/IPR
sonable alternative to staging procedures, doing more invasive
placement.
reconstructions, or not reconstructing and to encourage other
Conclusions: Frequently utilized tools for assessing frailty
surgeons to include this flap in their armamentarium.
and need for additional care, such as the CCI and mFI-11, may
Methods: A retrospective chart review was performed on
be inadequate in a head and neck reconstructive population.
patients undergoing TORRT with limited pharyngectomy as
Simpler measures such as age and BMI of less than 19 appear
well as concomitant neck dissection for the treatment of oroto have value in predicting whether a patient will likely require
pharyngeal squamous cell carcinoma (OPSCC) between May
further care at an SNF or IPR. Patient-associated comorbidi2011 and November 2019 performed by the senior author at
ties (CCI), ASA category, and whether a patient is taking oral
the University of Arkansas for Medical Sciences. The rate of
intake appear to have predictive value in terms of LOS.
fistula formation when ABDMF was preemptively used for
reconstruction was assessed.
Prognostic Impact of Metastatic Site in
Results: A total of 117 patients underwent transoral robotic surPatients With Distant Metastatic Head and
gery. Of these 49 patients underwent TORRT and simultaneous
Neck Cancer: A Multi-institutional Study
ND. Thirty-two of these patients underwent preemptive reconCraig A. Bollig, MD (Presenter); Christopher I. Newberry, MD;
struction with an ABDMF. Three patients underwent reconstrucElyse K. Hanly, MD, PhD; Vivian L. Zhu, MD; Nitin A.
tion with a sternocleidomastoid muscle flap (SCMMF). Zero out
Pagedar, MD; Rohit Nallani, MD; Andres M. Bur, MD;
of 35 patients that underwent ABDMF or SCMMF flap develJeffrey B. Jorgensen, MD
oped a fistula in the postoperative period. One out of the 14
Objectives: The development of distant metastatic disease
patients who did not have reconstruction formed a fistula. There
(M1) in head and neck cancer (HNC) patients is associated
was no associated morbidity with the use of either flap.
Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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