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  1. Article ; Online: Non-protective immunity after standard pneumococcal vaccination series identified as a potential contributing risk factor for refractory otolaryngologic conditions in children.

    Bonaventure, Caroline A / Evans, Adele K

    The Annals of otology, rhinology, and laryngology

    2023  Volume 133, Issue 1, Page(s) 37–42

    Abstract: Objective: To examine the relationship between conferred immunity after standard pneumococcal series and refractory otolaryngologic infections in pediatric patients using post-vaccination antibody titers, and to identify contributory underlying ... ...

    Abstract Objective: To examine the relationship between conferred immunity after standard pneumococcal series and refractory otolaryngologic infections in pediatric patients using post-vaccination antibody titers, and to identify contributory underlying conditions revealed when vaccination/re-vaccination fails to confer protective immunity.
    Study design: IRB-reviewed and "exempt" retrospective case series with chart review using the Epic
    Setting: Dedicated tertiary referral children's hospital.
    Methods: Pneumococcal antibody titer results were assessed for children ages 0 to 21 years and: (1) at least 1 of 7 otolaryngologic disease diagnoses and (2) having received the 4-dose schedule of pneumococcal conjugate vaccine (PCV 7 or 13).
    Results: A total of 241 subjects met inclusion criteria with 356 laboratory tests. Recurrent acute otitis media, chronic rhinitis, and chronic otitis media with effusion were the 3 most frequent diagnoses. At presentation, only 27.0% of subjects had titers conferring immunity from their prior vaccinations with PCV. About 85 subjects had been subsequently revaccinated with Pneumococcal Polysaccharide Vaccine (PPSV), and antibody responses conferring immunity reached 91.8%. Seven subjects never developed adequate responses; 5 of these had recurrent acute otitis media as the primary otolaryngologic diagnosis. Secondary "revealed" diagnoses included Juvenile Rheumatoid Arthritis (n = 1), unresolved specific antibody deficiency (n = 2), and Hypogammaglobulinemia (n = 1).
    Conclusion: In pediatric patients with recurrent infectious otolaryngologic disease refractory to traditional medical and surgical therapy, inadequate responses to pneumococcal vaccination may be revealed. This correlation represents a potential pathway for diagnosis and therapy.
    MeSH term(s) Child ; Humans ; Otitis Media/drug therapy ; Pneumococcal Infections/prevention & control ; Pneumococcal Infections/drug therapy ; Pneumococcal Vaccines/adverse effects ; Retrospective Studies ; Risk Factors ; Streptococcus pneumoniae ; Vaccination
    Chemical Substances Pneumococcal Vaccines
    Language English
    Publishing date 2023-06-29
    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 10.1177/00034894231182745
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Outcomes of Head and Neck Free Tissue Transfer in Renal Failure Patients.

    Oglesby, Kacie R / Jefferson, Gina D / Thomas, Carissa M / Tomblin, Caitlyn / Alnemri, Angela / Curry, Joseph M / Bonaventure, Caroline / Sweeny, Larissa / Richards, Holden W / Wax, Mark / Kane, Anne C

    The Laryngoscope

    2023  Volume 134, Issue 2, Page(s) 688–694

    Abstract: Objective: To assess if there is increased risk of free flap failure in renal failure patients undergoing head and neck reconstruction. We seek to primarily assess free flap outcomes based on stages of chronic kidney disease (CKD) and secondarily ... ...

    Abstract Objective: To assess if there is increased risk of free flap failure in renal failure patients undergoing head and neck reconstruction. We seek to primarily assess free flap outcomes based on stages of chronic kidney disease (CKD) and secondarily determine increased risk for postoperative complications.
    Methods: Retrospective chart review was performed at five tertiary care centers. Patients were identified that had undergone microvascular free flap reconstruction of the head and neck with diagnosis of renal failure, classified as Stage 3 CKD or higher. Demographic data was collected. Outcomes in the postoperative period were examined.
    Results: Seventy-three patients met inclusion criteria. The average patient age was 69 years with a male predominance (n = 48). The majority of patients had CKD Stage 3 (n = 52). Overall flap failure rate was 12.33% (n = 9, CKD stage 3 = 7.69%, CKD stage 4 = 30%, CKD stage 5 = 18%). There was an increased risk of flap failure on multivariate analysis for CKD stage 4/5 patients when compared to CKD 3 patients (p = 0.0095). When compared to matched controls, there was an increased risk of flap failure in CKD patients (p = 0.01) as well as an increased risk of overall complications (p < 0.0001).
    Conclusions: Patients with CKD undergoing head and neck reconstruction are at a higher risk of flap failure and overall complications. When comparing CKD stages there may be increased risk of flap failure in later stages of CKD compared to CKD 3. Appropriate patient counseling is recommended pre-operatively in this patient population with consideration for regional flaps in the appropriate patient.
    Level of evidence: 3 Laryngoscope, 134:688-694, 2024.
    MeSH term(s) Humans ; Male ; Aged ; Female ; Retrospective Studies ; Head and Neck Neoplasms/complications ; Head and Neck Neoplasms/surgery ; Neck/surgery ; Free Tissue Flaps/blood supply ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Renal Insufficiency/complications ; Renal Insufficiency, Chronic/complications
    Language English
    Publishing date 2023-07-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80180-x
    ISSN 1531-4995 ; 0023-852X
    ISSN (online) 1531-4995
    ISSN 0023-852X
    DOI 10.1002/lary.30862
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Factors Impacting Discharge Destination Following Head and Neck Microvascular Reconstruction.

    Sweeny, Larissa / Slijepcevic, Allison / Curry, Joseph M / Philips, Ramez / Bonaventure, Caroline A / DiLeo, Michael / Luginbuhl, Adam J / Crawley, Meghan B / Guice, Kelsie M / McCreary, Eleanor / Buncke, Michelle / Petrisor, Daniel / Wax, Mark K

    The Laryngoscope

    2022  Volume 133, Issue 1, Page(s) 95–104

    Abstract: Objective: Determine which variables impact postoperative discharge destination following head and neck microvascular free flap reconstruction.: Study design: Retrospective review of prospectively collected databases.: Methods: Consecutive ... ...

    Abstract Objective: Determine which variables impact postoperative discharge destination following head and neck microvascular free flap reconstruction.
    Study design: Retrospective review of prospectively collected databases.
    Methods: Consecutive patients undergoing head and neck microvascular free flap reconstruction between January 2010 and December 2019 (n = 1972) were included. Preoperative, operative and postoperative variables were correlated with discharge destination (home, skilled nursing facility [SNF], rehabilitation facility, death).
    Results: The mean age of patients discharged home was lower (60 SD ± 13, n = 1450) compared to those discharged to an SNF (68 SD ± 14, n = 168) or a rehabilitation facility (71 SD ± 14, n = 200; p < 0.0001). Operative duration greater than 10 h correlated with a higher percentage of patients being discharged to a rehabilitation or SNF (25% vs. 15%; p < 0.001). Patients were less likely to be discharged home if they had a known history of cardiac disease (71% vs. 82%; p < 0.0001). Patients were less likely to be discharged home if they experienced alcohol withdrawal (67% vs. 80%; p = 0.006), thromboembolism (59% vs. 80%; p = 0.001), a pulmonary complication (46% vs. 81%; p < 0.0001), a cardiac complication (46% vs. 80%; p < 0.0001), or a cerebral vascular event (25% vs. 80%; p < 0.0001). There was no correlation between discharge destination and occurrence of postoperative wound infection, salivary fistula, partial tissue necrosis or free flap failure. Thirty-day readmission rates were similar when stratified by discharge destination.
    Conclusion: There was no correlation with the anatomic site, free flap donor selection, or free flap survival and discharge destination. Patient age, operative duration and occurrence of a medical complication postoperatively did correlate with discharge destination.
    Level of evidence: 4 Laryngoscope, 133:95-104, 2023.
    MeSH term(s) Humans ; Alcoholism/complications ; Risk Factors ; Substance Withdrawal Syndrome/complications ; Free Tissue Flaps/blood supply ; Patient Discharge ; Retrospective Studies ; Head and Neck Neoplasms/surgery ; Head and Neck Neoplasms/complications ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology
    Language English
    Publishing date 2022-05-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80180-x
    ISSN 1531-4995 ; 0023-852X
    ISSN (online) 1531-4995
    ISSN 0023-852X
    DOI 10.1002/lary.30149
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Ul II Zs.82: Show issues Location:
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  4. Article ; Online: Perioperative Hypercoagulability in Free Flap Reconstructions Performed for Intracranial Tumors.

    Lilly, Gabriela L / Sweeny, Larissa / Santucci, Nicole / Cannady, Steven / Frost, Ariel / Anagnos, Vincent / Curry, Joseph / Sagalow, Emily / Freeman, Cecilia / Puram, Sidharth V / Pipkorn, Patrik / Slijepcevic, Allison / Fuson, Andrew / Bonaventure, Caroline / Wax, Mark K

    The Laryngoscope

    2022  Volume 133, Issue 5, Page(s) 1103–1109

    Abstract: Objective(s): Patients with intracranial tumors have a higher risk of thromboembolic events. This risk increases at the time of surgical intervention. We have noted an anecdotal increase in perioperative flap thrombosis in patients undergoing free ... ...

    Abstract Objective(s): Patients with intracranial tumors have a higher risk of thromboembolic events. This risk increases at the time of surgical intervention. We have noted an anecdotal increase in perioperative flap thrombosis in patients undergoing free tissue transfer for intracranial tumor resection. This study aims to formally evaluate this risk.
    Methods: A multi-institutional retrospective chart review was performed of patients who underwent free tissue transfer for scalp/cranial reconstruction. Perioperative thrombosis and free flap outcomes were evaluated.
    Results: The 209 patients who underwent 246 free tissue transfers were included in the study. The 28 free flap scalp reconstructions were associated with intracranial tumors, 19 were performed following composite cranial resections with associated dural resection/reconstruction, and 199 were performed in the absence of intracranial tumors (control group). There was a significantly higher incidence of perioperative flap thrombosis in the intracranial tumor group (11/28, 39%) when compared to controls (38/199, 19%) (p = 0.0287). This was not seen when scalp tumors extended to the dura alone (4/19, 21%, p = 0.83). Therapeutic anticoagulation used for perioperative thrombosis (defined as intraoperative or in the immediate postoperative phase up to 5 days) was associated with a lower risk of flap failure, although this was not statistically significant (p = 0.148). Flap survival rates were equivalent between flaps performed for intracranial pathology (93.3%) and controls (95%).
    Conclusion: There is an increase in perioperative flap thrombosis in patients with intracranial tumors undergoing free tissue scalp reconstruction. Anticoagulation appears to mitigate this risk.
    Level of evidence: This recommendation is based on level 3 evidence (retrospective case-control studies, systematic review of retrospective studies, and case reports) Laryngoscope, 133:1103-1109, 2023.
    MeSH term(s) Humans ; Free Tissue Flaps ; Retrospective Studies ; Thrombophilia/complications ; Thrombophilia/drug therapy ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/drug therapy ; Thrombosis/etiology ; Anticoagulants/therapeutic use ; Brain Neoplasms/surgery
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2022-10-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80180-x
    ISSN 1531-4995 ; 0023-852X
    ISSN (online) 1531-4995
    ISSN 0023-852X
    DOI 10.1002/lary.30417
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  5. Article ; Online: Age and Comorbidities Impact Medical Complications and Mortality Following Free Flap Reconstruction.

    Sweeny, Larissa / Curry, Joseph M / Crawley, Meghan B / DiLeo, Michael / Bonaventure, Caroline A / Luginbuhl, Adam J / Guice, Kelsie M / Taghizadeh, Farshid / McCreary, Eleanor / Buncke, Michelle / Petrisor, Daniel / Wax, Mark K

    The Laryngoscope

    2021  Volume 132, Issue 4, Page(s) 772–780

    Abstract: Objective: Determine if age correlated with surgical or medical complications following head and neck free flap reconstruction.: Study design: Retrospective review of prospectively collected databases.: Methods: Patients undergoing head and neck ... ...

    Abstract Objective: Determine if age correlated with surgical or medical complications following head and neck free flap reconstruction.
    Study design: Retrospective review of prospectively collected databases.
    Methods: Patients undergoing head and neck free flap reconstruction at three tertiary care institutions were included (n = 1972). Cohorts were based on age (<65, 65-75, 75-85, and >85). Outcomes reviewed operative duration, length of stay, surgical complications (free flap failure, fistula, hematoma, dehiscence, and infection), and medical complications (thromboembolism, stroke, cardiac, and pulmonary).
    Results: Anatomic site (P < .0001) and donor site varied by age (P < .0001). There was no difference in operative duration (P = .3) or length of hospitalization (P = .8) by age. The incidence of medical complications increased with increasing age. Pulmonary complication rates: <65 (3.9%), 65 to 75 (4.8%), 75 to 85 (7.1%), and >85 (11%) (P = .02). Cardiac complication rates: <65 (2.0%), 65 to 75 (7.3%), 75 to 85 (6.1%), and >85 (16.4%) (P < .0001). Mortality increased with age: <65 (0.4%), 65 to 75 (0.8%), 75 to 85 (1.1%), and >85 (4.1%) (P < .003). Medical complications correlated with mortality rates: pulmonary (3.5% vs. 0.6%; OR: 5.5; 95% CI: 1.5-20.0; P = .004); cardiac (3.3% vs. 0.6%; OR: 6.0; 95% CI: 1.6-21.8; P = .002); thromboembolism (4.6% vs. 0.7%; OR: 7.3; 95% CI: 1.6-33.6; P = .003); stroke (42% vs. 0.5%; OR: 149; 95% CI: 40-558; P < .0001); and sepsis (5% vs. 0.7%; OR 7.5; 95% CI: 1.0-60.5; P = .03). Age did not correlate with free flap success (P = .5), surgical complications (hematoma, P = .33; fistula, P = .23; infection, P = .07; and dehiscence, P = .37), or thirty-day readmission (P = .3).
    Conclusion: Following free flap reconstruction, patient age did not correlate with development of a surgical complication. Patient age did correlate with development of a medical complication. Postoperative medical complications were found to correlate with perioperative mortality.
    Level of evidence: 4 Laryngoscope, 132:772-780, 2022.
    MeSH term(s) Free Tissue Flaps/adverse effects ; Free Tissue Flaps/surgery ; Head and Neck Neoplasms/surgery ; Hematoma/complications ; Humans ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Reconstructive Surgical Procedures/adverse effects ; Retrospective Studies ; Stroke/surgery ; Thromboembolism
    Language English
    Publishing date 2021-08-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80180-x
    ISSN 1531-4995 ; 0023-852X
    ISSN (online) 1531-4995
    ISSN 0023-852X
    DOI 10.1002/lary.29828
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Ul II Zs.82: Show issues Location:
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