Jeffrey B. Jorgensen

Obesity and perioperative complications in head and neck free tissue reconstruction.

Free tissue transfer is a mainstay in reconstruction of complex head and neck defects. The purpose of this study was to determine if perioperative complications were more common in patients with body mass index (BMI) >30 kg/m2 undergoing free flap reconstruction.

Ultrasound for Localization in Primary Hyperparathyroidism

Objective To evaluate the capability of ultrasound for preoperative localization in primary hyperparathyroidism. Study Design Prospective study. Setting Multi-institutional Midwest Head and Neck Cancer Consortium. Subjects and Methods Two hundred twenty patients who underwent preoperative localization and had parathyroid surgery were evaluated. The findings of preoperative localization studies were correlated with surgical findings. Results Preoperative ultrasonography, sestamibi scintigraphy, or both were obtained in 77%, 93%, and 69% of the patients, respectively. Preoperative ultrasonography and sestamibi scintigraphy localized an abnormality in 71% and 79% of patients, respectively. At the time of surgery, the localization by ultrasound was accurate in 82%. The accuracy of localization was similar for sestamibi scintigraphy (85%). In patients with inaccurate ultrasound localization, the sestamibi scintigraphy correctly identified the site of disease in only 45%. In patients with a nonlocalizing ultrasound, sestamibi scintigraphy was able to localize disease in only 47%, with 2 being in the mediastinum. Conclusions Ultrasonography is an acceptable initial localization study for patients with primary hyperparathyroidism. In patients with nonlocalizing ultrasound, sestamibi scintigraphy should be obtained, but can be expected to detect an abnormality in less than 50% of patients.

Use of fluorescent angiography to assess donor site perfusion prior to free tissue transfer

To describe a novel use of fluorescent angiography in assessing donor limb perfusion prior to free tissue harvest in microvascular free tissue transfer.

Economic Impact of Frozen Section for Thyroid Nodules with “Suspicious for Malignancy” Cytology:

Objective To perform a cost analysis of the routine use of intraoperative frozen section (iFS) among patients undergoing a thyroid lobectomy with “suspicious for malignancy” (SUSP) cytology in the context of the 2015 American Thyroid Association guidelines. Study Design Case series with chart review; cost minimization analysis. Setting Academic. Subjects and Methods Records were reviewed for patients with SUSP cytology who underwent thyroid surgery between 2010 and 2015 in which iFS was utilized. The diagnostic test performance of iFS and the frequency of indicated completion/total thyroidectomies based on the 2015 guidelines were calculated. A cost minimization analysis was performed comparing lobectomy, with and without iFS, and the need for completion thyroidectomy according to costs estimated from 2014 data from Medicare, the Bureau of Labor Statistics, and the Nationwide Inpatient Sample. Results Sixty-five patients met inclusion criteria. The malignancy rate was 61.5%, 45% of which was identified intraoperatively. The specificity and positive predictive value were 100%. The negative predictive value and sensitivity were 83% and 95%, respectively. Completion/total thyroidectomy was indicated for 9% of patients; 83% of these individuals had findings on iFS that would have changed management intraoperatively. Application of the new guidelines would have resulted in a significant reduction in the frequency of conversion to a total thyroidectomy when compared with the actual management (26.1% vs 7.7%, P = .005). Performing routine iFS was the less costly scenario, resulting in a savings of

Utility of Intraoperative Frozen Section in Large Thyroid Nodules

474 per case. Conclusion For patients with SUSP cytology undergoing lobectomy, routine use of iFS would result in decreased health care utilization.

Impact of perioperative hyperglycemia in patients undergoing microvascular reconstruction

Objective To determine if the routine use of intraoperative frozen section (iFS) results in cost savings among patients with nodules >4 cm with nonmalignant cytology undergoing a thyroid lobectomy. Study Design Case series with chart review; cost minimization analysis. Setting Single academic center. Subjects and Methods Records were reviewed on a consecutive sample of 48 patients with thyroid nodules >4 cm and nonmalignant cytology who were undergoing thyroid lobectomy in which iFS was performed between 2010 and 2015. A decision tree model of thyroid lobectomy with iFS was created. Comparative parameters were obtained from the literature. A cost minimization analysis was performed comparing lobectomy with and without iFS and the need for completion thyroidectomy with costs estimated according to 2014 data from Medicare, the Bureau of Labor Statistics, and the Nationwide Inpatient Sample. Results The overall malignancy rate was 25%, and 33% of these malignancies were identified intraoperatively. When the malignancy rates obtained from our cohort were applied, performing routine iFS was the less costly scenario, resulting in a savings of

Well-Differentiated Liposarcoma Localized to the Thyroid Gland

486 per case. When the rate of malignancy identified on iFS was adjusted, obtaining iFS remained the less costly scenario as long as the rate of malignancies identified on iFS exceeded 12%. If patients with follicular lesions on cytology were excluded, 50% of malignancies were identified intraoperatively, resulting in a savings of

The Effect of Intraoperative Hetastarch Administration on Microvascular Surgical Outcomes

768 per case. Conclusions For patients with nodules >4 cm who are undergoing a diagnostic lobectomy, the routine use of iFS may result in decreased health care utilization. Additional cost savings could be obtained if iFS is avoided among patients with follicular lesions.

Stretch of the Minimally Invasive Incision during Thyroid and Parathyroid Surgery

The effects of perioperative hyperglycemia on complications and outcomes in microvascular reconstruction have not been reported in the literature.

Management Challenges in Supernumerary Parathyroid Adenoma

Liposarcoma of the thyroid gland is a pathology that is rarely encountered in clinical practice, given the paucity of these cases. For the same reason, a definite treatment protocol has not been established for these cases. We present a case of a 49-year-old man who presented with a thyroid mass that was found to be a well-differentiated liposarcoma and was treated surgically with no adjuvant therapy other than close surveillance with clinical examination and MRI scans. On his most recent clinical visit, 9 months after surgery, there was no clinical or radiologic evidence of recurrence and the patient is doing well with good speech and swallow functions and no new symptoms. We also summarize all the cases of this rare pathology presented thus far to the best of our knowledge.