Karena Zhao’s research while affiliated with New York Presbyterian Hospital and other places

Objective To evaluate characteristics associated with increased cost and length of hospitalization of mandible fracture management. Study Design Retrospective chart review. Methods Demographics, injury mechanism, associated injuries, treatment information, and associated costs were collected for all patients treated for mandible fracture treated at a single institution over a 14‐year period. Univariable and multivariable analyses were performed to identify the patient and fracture characteristics associated with increased cost and length of hospitalization. Results We identified 552 patients with 834 mandible fractures from 2008 to 2022. Patients' mean age was 40 years, 67% were male, and 38% Caucasian. The median cost of treatment, adjusted for inflation, was $8,869.49, and median length of stay (LOS) was 3.0 days. Associated cranial/intracranial injury, transfer presentation, increased facial fractures, and traffic‐related injuries resulted in a significant increase in both cost and LOS. LOS had a significant impact on cost, while age also significantly increased LOS for patients with mandible fractures. Conclusions This study represents one of the largest comprehensive databases of mandible fractures and one of the first to provide a descriptive cost and inpatient burden analysis of mandible fracture management. To improve outcomes and reduce hospital cost and inpatient burden, protocols should be implemented to identify and mitigate factors that we identified as contributing to increased cost and length of hospitalization. Lay Summary This study represents one of the largest reviews of cost and inpatient burden of mandible fractures. We found that presentation via transfer, traffic‐related injuries, and more facial fractures were associated with significantly higher cost and longer length of hospitalization. Level of Evidence 4 Laryngoscope , 2024

Objectives Venous thromboembolic events (VTEs) are a leading cause of postoperative morbidity, prolonged hospital stay, and increased cost. Recommendations for mechano‐ and chemoprophylaxis are currently based on the 2005 Caprini score, a screening tool developed to identify patients at risk for VTE. The Caprini risk assessment model (RAM) was designed for surgical impatients and has been tested in a number of surgical fields, including otolaryngology. However, the vast majority of otolaryngology cases are performed as ambulatory surgery. Simpler RAMs include the COBRA scoring system and Pannucci‐NSQIP. Here, we evaluate risk stratification of otolaryngology surgical patients and correlate the findings of these three RAMs. Study Design Retrospective chart review. Methods A retrospective chart review of 869 patients undergoing surgery by Weill Cornell faculty otolaryngologists between June and December 2022 was performed. Patient demographics, VTE risk factors, admission status, surgical subservice, and postoperative events were collected, and RAM scores were calculated for each patient. Wilcoxon and Kruskal–Wallis rank‐sum tests were utilized to assess differences in VTE risk scores based on type of procedure and admission status, and Spearman's correlation was utilized to assess agreement between the three different scoring systems. Multivariate linear regressions were utilized to assess variables that impacted the Caprini, COBRA, and NSQIP RAMs. Results In total, two patients developed postoperative venous thromboembolism. Furthermore, there is a strong positive correlation between Caprini and COBRA RAMs (even when broken down by admission status, although it weakens in the inpatient population). There is a moderate positive correlation between Caprini and Pannucci‐NSQIP in the full cohort, but that correlation is lost in the inpatient population. Conclusions Otolaryngology surgical patients are at low risk of postoperative VTE. Caprini, Pannucci‐NSQIP, and COBRA RAMs correlate well in determining ambulatory patients at risk for postoperative VTE and shorter, simpler RAMS such as COBRA and Pannucci‐NSQIP can be used instead of Caprini RAM. Level of Evidence 3 Laryngoscope , 2024

The nose is a structure of both cosmetic and functional importance. Cutaneous lesions of the nose occasionally represent a diagnostic challenge and involve the expertise of several specialties from dermatology, otolaryngology—head and neck surgery, infectious disease, and pathology, among others. We present a review of salient features of malignant and benign cutaneous nasal lesions which are of importance to physicians treating these complicated pathologies.

Importance Facial trauma makes up a significant number of emergency room visits, with morbidity costs in excess of 1 billion dollars each year. Few studies have evaluated the economic outcomes of management and inpatient burden of facial trauma, most focusing solely on the mandible and isolated midface fractures. Objective The authors aim to evaluate characteristics associated with increased cost and length of hospitalization of zygoma fracture management. Design Cross-sectional study. Setting Level 1—trauma academic medical center. Participants Patients with zygoma fractures who presented to our institution from 2008 to 2021. Main Outcomes and Measures Demographics, injury mechanisms, associated injuries, treatment information, and associated costs were collected. Univariate and multivariate analyses were performed to identify the patient and fracture characteristics associated with increased cost and length of hospitalization. Results Our 14-year experience identified 689 patients with zygoma fractures who presented from 2008 to 2021. Seventy percent were male, and 40% occurred in Caucasian patients. The mean cost, adjusted for inflation, was $21,799.34, and the mean length of hospitalization was 5.5 days. Four or more fractures, associated cranial or intracranial injuries, and length of stay were associated with significantly higher cost, and 4 or more fractures, associated cranial or intracranial injuries, and female gender were associated with significantly longer length of hospitalization. Conclusions and Relevance This study represents one of the largest comprehensive databases of zygoma fractures and one of the first to provide a descriptive cost and inpatient burden analysis. To improve outcomes and reduce hospital cost and inpatient burden, protocols should be implemented to address the factors that the authors identified as contributing to increased cost and length of hospitalization.

Objective To discuss patient demographics and management and better understand the economic impact associated with the treatment of facial fractures at a major metropolitan level 1 trauma center. Study Design Retrospective chart review. Methods We identified 5088 facial fractures in 2479 patients who presented from 2008 to 2022. Patient demographics, mechanism of injury, associated injuries, treatment information, and hospital charges were collected and analyzed to determine factors associated with surgical management and increased cost burden. Results Our 14‐year experience identified 1628 males and 851 females with a mean age of 45.7 years. Orbital fractures were most common (41.2%), followed by maxilla fractures (20.8%). The most common mechanism was fall (43.0%). Surgical management was recommended for 41% of patients. The odds of surgical management was significantly lower in female patients, patients age 65 and older, and patients who presented after the onset of the COVID‐19 pandemic. The odds of surgical management was significantly higher for patients who had a mandible fracture or greater than 1 fracture. The average cost of management was highest for naso‐orbito‐ethmoidal fractures ($37,997.74 ± 52,850.88), followed by LeFort and frontal fractures ($29.814.41 ± 42,155.73 and $27,613.44 ± 39.178.53, respectively). The highest contributor to the total average cost of management was intensive care unit‐related costs for every fracture type, except for mandible fractures for which the highest contributor was operating room (OR)‐related costs. Conclusions This study represents one of the largest comprehensive databases of facial fractures and one of the first to provide a descriptive cost analysis of facial trauma management. Level of Evidence 4 Laryngoscope , 2024

Background Corynebacterium diphtheriae may cause respiratory or cutaneous infections, often with the formation of a pseudo-membrane in the tonsils, pharynx, nasopharynx, or larynx. Case Report We describe the case of a 42-year-old patient presenting with chronic sinusitis without polyposis with symptoms of forehead and malar pain and pressure that did not abate with conservative therapy. She opted for surgical management and operative cultures taken from the paranasal sinuses grew Corynebacterium diphtheriae Toxin A type. Patient's postoperative course was uneventful, and she completed diphtheria treatment with erythromycin. Conclusion Our case report highlights a previously unreported presentation of diphtheria infection of the paranasal sinuses and underlies the importance of considering this rare organism in patients with an unknown vaccination history from endemic areas with tenacious plaques of the oropharynx, nasopharynx, and nasal cavity.