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  1. Article ; Online: Opioid-Sparing Protocol for Endocrine Surgery (OSPREY): A Prospective Study.

    Kligerman, Maxwell P / Austerlitz, Joaquin / Orloff, Lisa A / Noel, Julia E

    Journal of the American College of Surgeons

    2023  Volume 237, Issue 4, Page(s) 655–662

    Abstract: ... 34 ± 5.87, p = 0.042) but had no significant difference in OBAS (p = 0.37). Multivariable ... for age, sex, and type of surgery (p = 0.88). There were no major adverse events in either group ...

    Abstract Background: Thyroid and parathyroid operations are among the most commonly performed surgeries in the world; however, there remains a paucity of prospective clinical trials evaluating the efficacy of opioid-sparing protocols after surgery.
    Study design: This prospective nonrandomized study was performed between March and October 2021. Participants self-selected their cohort of either an opioid-sparing protocol of acetaminophen/ibuprofen or a treatment-as-usual protocol with opioids. Primary endpoints were Overall Benefit of Analgesia Scores (OBAS) and opioid use as reported in daily medication logs. Data were recorded for 7 days. Multivariable regression, pooled variance t -tests, Mann-Whitney test, and chi-square tests were used to evaluate the results.
    Results: A total of 87 participants were recruited; 48 participants opted for the opioid-sparing arm, and 39 participants opted for the treatment-as-usual arm. Patients in the opioid-sparing arm used significantly fewer opioids (morphine equivalents 0.77 ± 1.71 vs 3.34 ± 5.87, p = 0.042) but had no significant difference in OBAS (p = 0.37). Multivariable regression analysis demonstrated no significant difference in mean OBAS between treatment arms when controlling for age, sex, and type of surgery (p = 0.88). There were no major adverse events in either group.
    Conclusions: An opioid-sparing treatment algorithm based on the use of acetaminophen/ibuprofen may offer a safe and effective treatment algorithm compared to a primary opioid-focused treatment pathway. Randomized adequately powered studies are needed to confirm these findings.
    MeSH term(s) Humans ; Analgesics, Opioid/therapeutic use ; Ibuprofen/therapeutic use ; Acetaminophen/therapeutic use ; Prospective Studies ; Pain, Postoperative/drug therapy ; Pain, Postoperative/prevention & control
    Chemical Substances Analgesics, Opioid ; Ibuprofen (WK2XYI10QM) ; Acetaminophen (362O9ITL9D)
    Language English
    Publishing date 2023-06-07
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1097/XCS.0000000000000782
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  2. Article ; Online: Physician-Assisted Suicide for Patients with Head and Neck Cancer.

    Kligerman, Maxwell P / Divi, Vasu

    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery

    2020  Volume 163, Issue 4, Page(s) 759–762

    Abstract: A retrospective observational cohort study was conducted using data from Oregon's Death with Dignity Act (DWDA) to characterize patients with head and neck cancer (HNC) who seek physician-assisted suicide (PAS). Between 1998 and 2018, a total of 57 ... ...

    Abstract A retrospective observational cohort study was conducted using data from Oregon's Death with Dignity Act (DWDA) to characterize patients with head and neck cancer (HNC) who seek physician-assisted suicide (PAS). Between 1998 and 2018, a total of 57 patients with HNC received DWDA prescriptions, of whom 39 (68.4%) died by administration of the prescribed medication. There were no associated complications with medication administration. The most commonly involved subsites were oral cavity (33.3%) and oropharynx (30.8%), and the most commonly cited end-of-life concerns were loss of ability to engage in activities that make life enjoyable (79.5%) and loss of autonomy (74.4%). There were no differences in age, race, marital status, or hospice enrollment rates between patients with HNC who died by administration and those who were prescribed but did not administer the medication. Patients who died by administration were generally less educated as compared to those who were prescribed but did not administer the medication (
    MeSH term(s) Aged ; Female ; Head and Neck Neoplasms ; Humans ; Male ; Oregon ; Retrospective Studies ; Right to Die/legislation & jurisprudence ; Socioeconomic Factors ; Suicide, Assisted/legislation & jurisprudence ; Suicide, Assisted/statistics & numerical data
    Language English
    Publishing date 2020-05-19
    Publishing country England
    Document type Journal Article ; Observational Study
    ZDB-ID 392085-9
    ISSN 1097-6817 ; 0161-6439 ; 0194-5998
    ISSN (online) 1097-6817
    ISSN 0161-6439 ; 0194-5998
    DOI 10.1177/0194599820923610
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  3. Article ; Online: Challenges facing otolaryngologists in low- and middle-income countries during the COVID-19 pandemic.

    Kligerman, Maxwell P / Lamour, Shaina / Okerosi, Samuel

    International journal of pediatric otorhinolaryngology

    2020  Volume 138, Page(s) 110322

    Abstract: The COVID-19 pandemic poses significant challenges for otolaryngologists practicing in low- and middle-income countries (LMICs). This commentary highlights some of the particular challenges in low resource settings, including limited testing, ... ...

    Abstract The COVID-19 pandemic poses significant challenges for otolaryngologists practicing in low- and middle-income countries (LMICs). This commentary highlights some of the particular challenges in low resource settings, including limited testing, insufficient personal protective equipment, small numbers of surgeons, and competing socio-economic demands. The commentary focuses on specific examples from around the world to draw attention to these challenges and also highlight examples of success and innovation. Amidst the crisis an opportunity exists for otolaryngologists from around the world to share resources, ideas, and innovations to best serve patients and improve the health system globally for the future.
    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Developing Countries ; Health Resources ; Humans ; Otolaryngologists ; Pandemics ; Personal Protective Equipment/economics ; Pneumonia, Viral ; Poverty ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-08-18
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 754501-0
    ISSN 1872-8464 ; 0165-5876
    ISSN (online) 1872-8464
    ISSN 0165-5876
    DOI 10.1016/j.ijporl.2020.110322
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  4. Article ; Online: Cost-Effectiveness of Depression Screening for Otolaryngology-Head and Neck Surgery Residents.

    Kligerman, Maxwell P / Devine, Erin E / Bentzley, Jessica P / Megwalu, Uchechukwu C

    The Laryngoscope

    2020  Volume 131, Issue 3, Page(s) 502–508

    Abstract: Objectives: This study aims to determine the cost-effectiveness of screening and treating otolaryngology-head and neck surgery residents for depression.: Methods: A Markov model was built using TreeAgePro, version 2019 (TreeAge Software Inc.; ... ...

    Abstract Objectives: This study aims to determine the cost-effectiveness of screening and treating otolaryngology-head and neck surgery residents for depression.
    Methods: A Markov model was built using TreeAgePro, version 2019 (TreeAge Software Inc.; Williamstown, MA) to assess the cost-effectiveness of five potential treatment algorithms: 1) treat all residents with psychotherapy, 2) screen and treat depressed residents with psychotherapy, 3) screen and treat depressed residents with pharmacotherapy, 4) screen and treat depressed residents with combination psychotherapy/pharmacotherapy, and 5) no intervention. A Monte Carlo probabilistic sensitivity analysis (PSA), consisting of 1 thousand simulations over a cumulative 5-year period, was performed to evaluate both base case values and a range of values for model variables.
    Results: Screening residents for depression and treating with combination psychotherapy/pharmacotherapy was cost-effective and the optimal strategy at a willingness-to-pay threshold of $50 thousand per quality-adjusted life year (QALY). This option demonstrated an incremental cost-effectiveness ratio of $27,578 per QALY for base case values. PSA confirmed these results and demonstrated that screening residents for depression and treating with either combination pharmacotherapy/psychotherapy, pharmacotherapy alone, or psychotherapy alone were cost-effective options in 94.9% of simulations.
    Conclusion: Depression and burnout remain crucial issues among resident physicians. This study demonstrates that actively screening residents for depression is cost-effective. Based on these results, residency programs may consider trialing standardized depression screening protocols.
    Level of evidence: I and II. Laryngoscope, 131:502-508, 2021.
    MeSH term(s) Adult ; Cost-Benefit Analysis ; Depression/diagnosis ; Depression/psychology ; Depression/therapy ; Female ; Humans ; Internship and Residency ; Male ; Markov Chains ; Mass Screening/economics ; Medical Staff, Hospital/psychology ; Occupational Diseases/diagnosis ; Occupational Diseases/psychology ; Occupational Diseases/therapy ; Otolaryngology/education ; Psychotherapy/economics
    Language English
    Publishing date 2020-06-08
    Publishing country United States
    Document type Evaluation Study ; Journal Article
    ZDB-ID 80180-x
    ISSN 1531-4995 ; 0023-852X
    ISSN (online) 1531-4995
    ISSN 0023-852X
    DOI 10.1002/lary.28780
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  5. Article ; Online: Tracheostomy Complications in the Emergency Department: A National Analysis of 38,271 Cases.

    Kligerman, Maxwell P / Saraswathula, Anirudh / Sethi, Rosh K / Divi, Vasu

    ORL; journal for oto-rhino-laryngology and its related specialties

    2020  Volume 82, Issue 2, Page(s) 106–114

    Abstract: ... Pediatric patients were significantly more likely to have tracheostomy infections than adults (p < 0.0001 ... adjusted odds ratio [OR]: 1.35; p = 0.0009), as did patients with tracheostomy infections (OR: 4.425; p < 0 ... 0001). Patients with tracheostomy infections (OR: 3.14; p = 0.0062) and unspecified tracheostomy ...

    Abstract Background: Greater than 100,000 tracheotomies are performed annually in the USA, yet little is known regarding patients who present to the emergency department (ED) with tracheostomy complications.
    Objectives: To characterize patient and hospital characteristics, outcomes, and charges associated with tracheostomy complications and to identify predictors of admission and mortality.
    Methods: The 2009-2011 Nationwide Emergency Department Sample (NEDS) was queried for patients with a principle diagnosis of tracheostomy complication. A descriptive analysis was performed and multivariable logistic regression was used to identify predictors of admission and mortality.
    Results: A total of 69,371 nationwide visits to the ED had tracheostomy complication as an associated ICD-9 diagnosis, of which 55.2% (n = 38,293) carried a primary diagnosis of tracheostomy complication. Unspecified tracheostomy complications were most common (61.4%), followed by mechanical complications (31.3%), and lastly by tracheostomy infections (7.3%). Pediatric patients were significantly more likely to have tracheostomy infections than adults (p < 0.0001). A total of 35.5% of patients with tracheostomy complications were admitted to the hospital, and death occurred with 1.4% of visits. Patients from higher-income ZIP codes had increased odds of admission (adjusted odds ratio [OR]: 1.35; p = 0.0009), as did patients with tracheostomy infections (OR: 4.425; p < 0.0001). Patients with tracheostomy infections (OR: 3.14; p = 0.0062) and unspecified tracheostomy complications (OR: 2.00; p = 0.0076) had increased odds of mortality.
    Conclusion: These findings may help improve overall outcomes amongst patients with tracheostomies by preventing unnecessary ED admissions and improving healthcare provider preparedness and awareness.
    MeSH term(s) Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Emergency Service, Hospital ; Female ; Hospitalization ; Humans ; Infant ; Infant, Newborn ; Logistic Models ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Retrospective Studies ; Tracheostomy/adverse effects ; Tracheostomy/statistics & numerical data ; United States ; Young Adult
    Language English
    Publishing date 2020-02-07
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 121482-2
    ISSN 1423-0275 ; 0301-1569
    ISSN (online) 1423-0275
    ISSN 0301-1569
    DOI 10.1159/000505130
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  6. Article ; Online: Comparison of Parotidectomy With Observation for Treatment of Pleomorphic Adenoma in Adults.

    Kligerman, Maxwell P / Jin, Michael / Ayoub, Noel / Megwalu, Uchechukwu C

    JAMA otolaryngology-- head & neck surgery

    2020  Volume 146, Issue 11, Page(s) 1027–1034

    Abstract: Importance: There is no consensus regarding optimal management of pleomorphic adenoma in adults.: Objectives: To compare parotidectomy with observation for the management of pleomorphic adenoma in patients 50 years or older by age.: Design and ... ...

    Abstract Importance: There is no consensus regarding optimal management of pleomorphic adenoma in adults.
    Objectives: To compare parotidectomy with observation for the management of pleomorphic adenoma in patients 50 years or older by age.
    Design and setting: This decision analytical model was performed from November 21, 2019, to June 15, 2020, using a Markov model. Model variables and ranges were selected based on a literature review. A 1-way sensitivity analysis was performed to evaluate the age threshold at which each algorithm, either upfront elective parotidectomy or observation, would be favored. A Monte Carlo probabilistic sensitivity analysis using variable ranges was then performed 5 times with patients in the model assigned a starting age of 50, 60, 70, 80, and 90 years to assess how age at diagnosis would be associated with the model results.
    Main outcomes and measures: Model outcomes were measured with quality-adjusted life-years (QALYs).
    Results: In the study models, the age thresholds at which observation became more beneficial than parotidectomy were 88.5 years for patients with superficial lobe tumors (5.37 QALYs in favor of parotidectomy below this age, and 5.37 QALYs in favor of observation above this age) and 83.4 years for patients with deep lobe tumors (7.51 QALYs in favor of surgery below this age, and 7.51 QALYs in favor of observation above this age). There was no significant difference in outcomes between parotidectomy and observation among patients aged 70 to 80 years.
    Conclusions and relevance: This study suggests that the outcomes associated with parotidectomy and observation are similar at 70 years or older among patients with pleomorphic adenoma and that observation may be the favorable treatment in that age group.
    MeSH term(s) Adenoma, Pleomorphic/diagnosis ; Adenoma, Pleomorphic/surgery ; Aged ; Aged, 80 and over ; Decision Making ; Elective Surgical Procedures/methods ; Female ; Humans ; Male ; Middle Aged ; Otorhinolaryngologic Surgical Procedures/methods ; Parotid Gland/diagnostic imaging ; Parotid Gland/surgery ; Parotid Neoplasms/diagnosis ; Parotid Neoplasms/surgery ; Quality-Adjusted Life Years ; Retrospective Studies
    Language English
    Publishing date 2020-11-12
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Observational Study
    ZDB-ID 2701825-8
    ISSN 2168-619X ; 2168-6181
    ISSN (online) 2168-619X
    ISSN 2168-6181
    DOI 10.1001/jamaoto.2020.2944
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  7. Article ; Online: Impact of Histologic Risk Factors on Recurrence Rates for Oral Cavity Squamous Cell Carcinoma.

    Kligerman, Maxwell P / Moon, Peter K / Tusty, Mahbuba / Cloutier, Jeffrey M / Ma, Yifei / Holsinger, Christopher F / Divi, Vasu

    The Annals of otology, rhinology, and laryngology

    2022  Volume 132, Issue 7, Page(s) 731–737

    Abstract: Objectives: This study assesses the impact of adverse histologic risk factors including worst pattern of invasion (WPOI), predominant pattern of invasion (PPOI), tumor budding, and tumor infiltrating lymphocytes (TILS), on risk of recurrence in patients ...

    Abstract Objectives: This study assesses the impact of adverse histologic risk factors including worst pattern of invasion (WPOI), predominant pattern of invasion (PPOI), tumor budding, and tumor infiltrating lymphocytes (TILS), on risk of recurrence in patients with early-stage Oral Cavity Squamous Cell Carcinoma (OCSCC).
    Methods: Retrospective chart review was performed at a single institution to identify patients with OCSCC who underwent surgical excision. Inclusion criteria included T1-T2 stage disease based on AJCC seventh edition guidelines, no cervical lymph node involvement, no perineural invasion (PNI), no lymphovascular invasion (LVI), no post-operative adjuvant radiation therapy, and cancer involving only the oral tongue or floor of mouth. Patients were excluded if they had positive final margins. A subset of 35 patients were selected for additional histologic review to determine WPOI, PPOI, TB, and TILS. Bivariable and multivariable cox analysis were performed to determine variables associated with recurrence.
    Results: One hundred and sixty-one patients met criteria and were included in the analysis. Variables that were significantly associated with recurrence on bivariable analysis included tumors with high risk PPOI (groups 4 and 5;
    Conclusions: TB is a strong predictor of recurrence. WPOI, PPOI, and TILS were not statistically significant risk factors for recurrence.
    MeSH term(s) Humans ; Squamous Cell Carcinoma of Head and Neck/pathology ; Retrospective Studies ; Neoplasm Staging ; Neoplasm Invasiveness ; Mouth Neoplasms/surgery ; Mouth Neoplasms/pathology ; Carcinoma, Squamous Cell/surgery ; Carcinoma, Squamous Cell/pathology ; Risk Factors ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Recurrence, Local/pathology ; Head and Neck Neoplasms/pathology ; Prognosis
    Language English
    Publishing date 2022-07-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 120642-4
    ISSN 1943-572X ; 0003-4894
    ISSN (online) 1943-572X
    ISSN 0003-4894
    DOI 10.1177/00034894221111223
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  8. Article ; Online: Intraoperative Corticosteroids for Voice Outcomes among Patients Undergoing Thyroidectomy: A Systematic Review and Meta-analysis.

    Noel, Julia E / Kligerman, Maxwell P / Megwalu, Uchechukwu C

    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery

    2018  Volume 159, Issue 5, Page(s) 811–816

    Abstract: Objective: To determine if a preoperative dose of intravenous corticosteroids reduces the risk of postoperative recurrent laryngeal nerve palsy and improves subjective voice outcomes among patients undergoing thyroidectomy.: Data sources: PubMed, ... ...

    Abstract Objective: To determine if a preoperative dose of intravenous corticosteroids reduces the risk of postoperative recurrent laryngeal nerve palsy and improves subjective voice outcomes among patients undergoing thyroidectomy.
    Data sources: PubMed, Cochrane database, and EMBASE.
    Review methods: Randomized controlled trials comparing corticosteroids with placebo on voice outcomes in thyroid surgery were extracted with standardized search criteria. Systematic review and meta-analysis were performed. With random effects models, trial data were pooled to determine the overall rate of recurrent laryngeal nerve palsy as well as secondary outcomes of adverse events, including wound infection and hyperglycemia.
    Results: Four studies with a total of 517 patients met inclusion criteria. The overall rate of recurrent laryngeal nerve palsy was 5.78%. There was no difference in the rate of palsy between the corticosteroid and placebo groups (risk ratio, 0.70; 95% CI, 0.34-1.44). There was also no difference between the groups in regard to wound infection, healing, or hyperglycemia.
    Conclusions: Preoperative corticosteroids do not appear to reduce the risk of recurrent laryngeal nerve palsy following thyroid surgery. There is insufficient evidence to assess its effect on subjective voice outcomes. More robust randomized controlled trials are needed to assess the effectiveness of perioperative steroids in improving voice outcomes after thyroidectomy.
    MeSH term(s) Adrenal Cortex Hormones/administration & dosage ; Female ; Humans ; Injections, Intralesional ; Intraoperative Care/methods ; Male ; Prognosis ; Randomized Controlled Trials as Topic ; Thyroidectomy/adverse effects ; Thyroidectomy/methods ; Treatment Outcome ; Vocal Cord Paralysis/prevention & control ; Voice Quality/drug effects
    Chemical Substances Adrenal Cortex Hormones
    Language English
    Publishing date 2018-08-07
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
    ZDB-ID 392085-9
    ISSN 1097-6817 ; 0161-6439 ; 0194-5998
    ISSN (online) 1097-6817
    ISSN 0161-6439 ; 0194-5998
    DOI 10.1177/0194599818793414
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  9. Article: Challenges facing otolaryngologists in low- and middle-income countries during the COVID-19 pandemic

    Kligerman, Maxwell P / Lamour, Shaina / Okerosi, Samuel

    Int J Pediatr Otorhinolaryngol

    Abstract: The COVID-19 pandemic poses significant challenges for otolaryngologists practicing in low- and middle-income countries (LMICs). This commentary highlights some of the particular challenges in low resource settings, including limited testing, ... ...

    Abstract The COVID-19 pandemic poses significant challenges for otolaryngologists practicing in low- and middle-income countries (LMICs). This commentary highlights some of the particular challenges in low resource settings, including limited testing, insufficient personal protective equipment, small numbers of surgeons, and competing socio-economic demands. The commentary focuses on specific examples from around the world to draw attention to these challenges and also highlight examples of success and innovation. Amidst the crisis an opportunity exists for otolaryngologists from around the world to share resources, ideas, and innovations to best serve patients and improve the health system globally for the future.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #718781
    Database COVID19

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  10. Article ; Online: Challenges facing otolaryngologists in low- and middle-income countries during the COVID-19 pandemic.

    Kligerman, Maxwell P / Lamour, Shaina / Okerosi, Samuel / Global OHNS Initiative

    2020  

    Abstract: The COVID-19 pandemic poses significant challenges for otolaryngologists practicing in low- and middle-income countries (LMICs). This commentary highlights some of the particular challenges in low resource settings, including limited testing, ... ...

    Abstract The COVID-19 pandemic poses significant challenges for otolaryngologists practicing in low- and middle-income countries (LMICs). This commentary highlights some of the particular challenges in low resource settings, including limited testing, insufficient personal protective equipment, small numbers of surgeons, and competing socio-economic demands. The commentary focuses on specific examples from around the world to draw attention to these challenges and also highlight examples of success and innovation. Amidst the crisis an opportunity exists for otolaryngologists from around the world to share resources, ideas, and innovations to best serve patients and improve the health system globally for the future.
    Keywords Global OHNS Initiative ; COVID-19 ; Global health ; Global otolaryngology ; Low- and middle-income countries ; Clinical Sciences ; Paediatrics and Reproductive Medicine ; covid19
    Publishing date 2020-08-18
    Publisher eScholarship, University of California
    Publishing country us
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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