Elderly patients are less likely to be discharged home after free flap reconstruction. Age, ASA score, and length of stay are independent factors for discharge to a nursing or other care facility.

Background Tobacco use is a risk factor for head and neck cancer, but effects on postoperative outcomes are unclear. Methods Head and neck cancer patients (N=89) were recruited before surgery. We assessed self-reported tobacco use status (never, former current) at study entry and recent tobacco exposure via urinary cotinine on surgery day. Outcomes included length of hospital stay (LOS) and complications. Results Most participants reported current (32.6%) or former (52.8%) tobacco use; 43.2% were cotinine positive on surgery day. Complications occurred in 41.6%; mean LOS was 4.0 and 8.8 days in patients who received low and high acuity procedures, respectively. Current and former smokers were over six times more likely to have complications than never smokers (p=.03). For high acuity procedures, LOS was increased in current (by 4.4 days) and former smokers (by 2.3 days, p=0.02). Conclusions Tobacco use status is associated with postoperative complications and may distinguish at risk patients.

Supraglottic Botox injection is an effective treatment for ADSD. Postinjection voice is significantly improved, and the majority of patients do not experience breathy voice/decline in vocal function after injection.

Objective Head and neck squamous cell carcinoma (HNSCC) patients who smoke are at risk for poor treatment outcomes. This study evaluated symptom burden and clinical, sociodemographic and psychosocial factors associated with smoking in surgical patients to identify potential targets for supportive care services. Study Design Cross-sectional survey. Methods Individuals with HNSCC of the oral cavity, larynx or pharynx were recruited from two cancer centers and completed questionnaires assessing smoking status (never, former, current/recent), patient characteristics and symptoms before surgery. Results Of the 103 patients enrolled, 73% were male, 52% were stage IV, 41% reported current/recent smoking and 37% reported former smoking. Current/recent smokers were less likely than former smokers to have adequate finances (53% vs. 89%, p=.001) and be married/partnered (55% vs. 79%, p=.03). Current/recent smokers were also more likely than both former and never smokers to be unemployed (49% vs. 40% and 13%, respectively, p’s=0.02) and lack health insurance (17% vs. 5% and 13%, respectively, p’s≤.04). Fatalistic beliefs (p=.03) and lower religiosity (p=0.04) were more common in current/recent than never smokers. In models adjusted for sociodemographic/clinical factors, current/recent smokers reported more problems than former and never smokers with swallowing, speech, and cough (p≤.04). Current/recent smokers also reported more problems than never smokers with social contact, feeling ill and weight loss (p≤.02). Conclusions HNSCC patients reporting current/recent smoking before surgery have high-risk clinical and sociodemographic features that may predispose them to poor postoperative outcomes. Unique symptoms in HNSCC smokers may be useful targets for patient-centered clinical monitoring and intervention.

Objective In cancer patients, cigarette smoking causes poorer response to treatment, treatment toxicity, increased risk of recurrence, higher surgical complication rates, and poorer overall survival. As such a significant determinant of patient prognosis, accurate classification of current smoking status is important. Self-reported smoking status may lead to misclassification if patients conceal their true status. The purpose of this study was to assess the validity of self-reported tobacco use during the previous 48 hours in head and neck cancer patients on the day of surgery. Study Design Cross-sectional. Setting Two academic medical centers in the southeastern United States. Subjects and Methods On the day of surgery, 108 head and neck cancer patients completed a survey asking about tobacco use during the past 48 hours and had semi-quantitative levels of urinary cotinine measured to biochemically validate self-reported recent smoking. Results Self-reported smoking yielded a sensitivity of 60.9% (95% CI, 45.4%-74.9%) and a specificity of 98.4% (95% CI, 91.3%-100.0%). The sensitivity increased to 76.1% (95% CI, 61.2%-87.4%) when allowing for the possibility that exposure to secondhand smoke or use of nicotine-containing products could have caused a positive cotinine test. Conclusion In this patient population, self-reported recent smoking yielded a high (39%) proportion of false-negatives, and even 24% remained false-negatives after allowing for other sources of nicotine exposure. This magnitude of underreporting combined with the importance of tobacco use to patient prognosis supports the need for routinely biochemically verifying recent tobacco use in self-reported nonsmokers within the clinical setting.