Highlights from the Current Issue: December 2018

H appy holidays! We made it through 2018 and have entered the winter holiday season. This is always an amazing time of year, and it’s important for us to stop and consider all of the paths that have allowed us to arrive here this month. All traditions celebrate this time of year, and we stop to contemplate the months behind us and the year ahead. We showcase in this month’s Highlights 5 papers that illustrate outstanding manuscripts in this current issue. In our first paper, Farquhar and colleagues examine the independent predictors of adverse outcomes, flap survival, and prolonged hospitalization in patients undergoing free flap reconstruction of the head and neck. The authors examined a patient cohort of 170 free flap reconstructive procedures at their institution over a 7-year period. They noted that this patient sample had a complication rate of 44%, with partial or complete flap failure in 11% and prolonged hospitalization in 27%. In examining patient characteristics among patients with and without major complications, the authors determined that independent predictors of complications included age .60 years, revision surgery, and history of neck dissection. Independent predictors of flap failure included revision surgery and use of a reconstruction plate. They also noted that the use of a radial forearm flap was associated with shorter hospital stays than other flap types. Farquhar et al discuss these observations and present recommendations for decreasing morbidity in patients undergoing free flap reconstruction. In our second paper, Saraswathula and Megwalu evaluate the impact of insurance status on survival among patients with salivary gland cancer. Using the Surveillance, Epidemiology, and End Results database, the authors examined 2755 patients with salivary gland cancer \65 years of age from 2007 to 2013. In their analysis, the authors noted that uninsured patients and patients with Medicaid were more likely than patients with commercial insurance to present with stage III/IV disease and distant metastases. They also noted that these patients had a lower overall survival than patients with commercial insurance. Given these findings, Saraswathula and Megwalu demonstrate an association of insurance status with disease presentation and overall survival and discuss implications for clinical practice and further research. In the third paper, Jang and associates examine recent practice patterns in patients treated with balloon dilation of the sinuses (BCD). Using a large national claims–based database, the authors evaluated 173,621 unique patients who underwent sinus surgery from 2011 to 2014, with 149,879 undergoing functional endoscopic sinus surgery, 13,653 undergoing BCD, and 10,089 undergoing hybrid procedures. While the authors noted that the incidence of chronic rhinosinusitis remained stable over the 4-year period of the study, the proportion of those undergoing BCD increased from 2.7% in 2011 to 13.7% in 2014, while the proportion of those undergoing functional endoscopic sinus surgery decreased from 92.2% in 2011 to 79.6% in 2014. They also noted that accompanying this increase in BCD procedures was an increase of procedures being completed in the office setting, as well as a higher incidence of headache disorders among patients undergoing BCD. Given these results, Jang and colleagues note that further research is necessary to ‘‘determine the reasons for these disparities, as they may be indicators of inappropriate utilization.’’ In the fourth manuscript, Lou and Lou compare the outcomes of treatment for traumatic tympanic membrane perforations with epidermal growth factor (EGF) and gelatin sponge patches. Using a randomized controlled methodology, the authors evaluated 141 patients with tympanic membrane perforations, 47 each in 3 groups treated with EGF, gelatin sponge patches, or spontaneous healing. They followed their patients for 6 months and compared closure rates among the 3 groups. They noted that treatment with gelatin sponge patching or EGF demonstrated a significantly higher closure rate than that of patients observed for spontaneous healing, although the 2 treatment groups did not significantly differ from each other in overall healing. Lou and Lou further describe some observations of the healing patterns among their 2 active treatment arms and suggest the need for selection of appropriate treatment methodology based on individual patient need. Finally, in our fifth manuscript, Panwar and colleagues assess factors that predict discharge to intermediate care facilities following total laryngectomy. Using the American College of Surgeons’ National Surgical Quality