IU Indianapolis ScholarWorks :: Browsing by Author "Moore, Michael G."

Browsing by Author "Moore, Michael G."

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Ability of the National Surgical Quality Improvement Program Risk Calculator to Predict Complications Following Total Laryngectomy
(JAMA, 2016-10) Schneider, Alexander L.; Deig, Christopher R.; Prasad, Kumar G.; Nelson, Benton G.; Mantravadi, Avinash V.; Brigance, Joseph S.; Langer, Mark P.; McDonald, Mark W.; Johnstone, Peter A.; Moore, Michael G.; Department of Otololaryngology-Head and Neck Surgery, School of Medicine
Importance The accuracy of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) risk calculator has been assessed in multiple surgical subspecialties; however, there have been no publications doing the same in the head and neck surgery literature. Objective To evaluate the accuracy of the calculator’s predictions in a single institution’s total laryngectomy (TL) population. Design, Setting, and Participants Total laryngectomies performed between 2013 and 2014 at a tertiary referral academic center were evaluated using the risk calculator. Predicted 30-day outcomes were compared with observed outcomes for return to operating room, surgical site infection, postoperative pneumonia, length of stay, and venous thromboembolism. Main Outcomes and Measures Comparison of the NSQIP risk calculator’s predicted postoperative complication rates and length of stay to what occurred in this patient cohort using percent error, Brier scores, area under the receiver operating characteristic curve, and Pearson correlation analysis. Results Of 49 patients undergoing TL, the mean (SD) age at operation was 59 (9.3) years, with 67% male. The risk calculator had limited efficacy predicting perioperative complications in this group of patients undergoing TL with or without free tissue reconstruction or preoperative chemoradiation or radiation therapy with a few exceptions. The calculator overestimated the occurrence of pneumonia by 165%, but underestimated surgical site infection by 7%, return to operating room by 24%, and length of stay by 13%. The calculator had good sensitivity and specificity of predicting surgical site infection for patients undergoing TL with free flap reconstruction (area under the curve, 0.83). For all other subgroups, however, the calculator had poor sensitivity and specificity for predicting complications. Conclusions and Relevance The risk calculator has limited utility for predicting perioperative complications in patients undergoing TL. This is likely due to the complexity of the treatment of patients with head and neck cancer and factors not taken into account when calculating a patient’s risk.
Acute toxicity in comprehensive head and neck radiation for nasopharynx and paranasal sinus cancers: cohort comparison of 3D conformal proton therapy and intensity modulated radiation therapy.
(BMC, 2016) McDonald, Mark W.; Liu, Yuan; Moore, Michael G.; Johnstone, Peter A. S.; Department of Otolaryngology--Head & Neck Surgery, IU School of Medicine
Background: To evaluate acute toxicity endpoints in a cohort of patients receiving head and neck radiation with proton therapy or intensity modulated radiation therapy (IMRT). Methods: Forty patients received comprehensive head and neck radiation including bilateral cervical nodal radiation, given with or without chemotherapy, for tumors of the nasopharynx, nasal cavity or paranasal sinuses, any T stage, N0-2. Fourteen received comprehensive treatment with proton therapy, and 26 were treated with IMRT, either comprehensively or matched to proton therapy delivered to the primary tumor site. Toxicity endpoints assessed included g-tube dependence at the completion of radiation and at 3 months after radiation, opioid pain medication requirement compared to pretreatment normalized as equivalent morphine dose (EMD) at completion of treatment, and at 1 and 3 months after radiation. Results: In a multivariable model including confounding variables of concurrent chemotherapy and involved nodal disease, comprehensive head and neck radiation therapy using proton therapy was associated with a lower opioid pain requirement at the completion of radiation and a lower rate of gastrostomy tube dependence by the completion of radiation therapy and at 3 months after radiation compared to IMRT. Proton therapy was associated with statistically significant lower mean doses to the oral cavity, esophagus, larynx, and parotid glands. In subgroup analysis of 32 patients receiving concurrent chemotherapy, there was a statistically significant correlation with a greater opioid pain medication requirement at the completion of radiation and both increasing mean dose to the oral cavity and to the esophagus. Conclusions: Proton therapy was associated with significantly reduced radiation dose to assessed non-target normal tissues and a reduced rate of gastrostomy tube dependence and opioid pain medication requirements. This warrants further evaluation in larger studies, ideally with patient-reported toxicity outcomes and quality of life endpoints.
Advanced head and neck surgery training during the COVID-19 pandemic
(Wiley, 2020) Givi, Babak; Moore, Michael G.; Bewley, Arnaud F.; Coffey, Charles S.; Cohen, Marc A.; Hessel, Amy C.; Jalisi, Scharukh; Kang, Steven; Newman, Jason G.; Puscas, Liana; Shindo, Maisie; Shuman, Andrew; Thakkar, Punam; Weed, Donald T.; Chalian, Ara; Otolaryngology -- Head and Neck Surgery, School of Medicine
The COVID-19 pandemic has significantly impacted medical training. Here we assess its effect on head and neck surgical education. Methods Surveys were sent to current accredited program directors and trainees to assess the impact of COVID-19 on the fellow's experience and employment search. Current fellows' operative logs were compared with those of the 2018 to 2019 graduates. Results Despite reduction in operative volume, 82% of current American Head and Neck Society fellows have reached the number of major surgical operations to support certification. When surveyed, 86% of program directors deemed their fellow ready to enter practice. The majority of fellows felt prepared to practice ablative (96%), and microvascular surgery (73%), and 57% have secured employment to follow graduation. Five (10%) had a pending job position put on hold due to the pandemic. Conclusions Despite the impact of the COVID-19 pandemic, current accredited trainees remain well-positioned to obtain proficiency and enter the work-force.
Advanced head and neck surgery training during the COVID-19 pandemic
(Wiley, 2020) Givi, Babak; Moore, Michael G.; Bewley, Arnaud F.; Coffey, Charles S.; Cohen, Marc A.; Hessel, Amy C.; Jalisi, Scharukh; Kang, Steven; Newman, Jason G.; Puscas, Liana; Shindo, Maisie; Shuman, Andrew; Thakkar, Punam; Weed, Donald T.; Chalian, Ara; Otolaryngology -- Head and Neck Surgery, School of Medicine
Background The COVID-19 pandemic has significantly impacted medical training. Here we assess its effect on head and neck surgical education. Methods Surveys were sent to current accredited program directors and trainees to assess the impact of COVID-19 on the fellow's experience and employment search. Current fellows' operative logs were compared with those of the 2018 to 2019 graduates. Results Despite reduction in operative volume, 82% of current American Head and Neck Society fellows have reached the number of major surgical operations to support certification. When surveyed, 86% of program directors deemed their fellow ready to enter practice. The majority of fellows felt prepared to practice ablative (96%), and microvascular surgery (73%), and 57% have secured employment to follow graduation. Five (10%) had a pending job position put on hold due to the pandemic. Conclusions Despite the impact of the COVID-19 pandemic, current accredited trainees remain well-positioned to obtain proficiency and enter the work-force.
African Head and Neck Society Clinical Practice guidelines for thyroid nodules and cancer in developing countries and limited resource settings
(Wiley, 2020-08) Zafereo, Mark; Yu, Justin; Onakoya, Paul A.; Aswani, Joyce; Baidoo, Kenneth; Bogale, Mesele; Cairncross, Lydia; Cordes, Susan; Daniel, Adekunle; Diom, Evelyne; Maurice, Mpessa E.; Mohammed, Garba M.; Biadgelign, Melesse G.; Koné, Fatogoma I.; Itiere, Arnaud; Koch, Wayne; Konney, Anna; Kundiona, Innocent; Macharia, Chege; Mashamba, Victor; Moore, Michael G.; Mugabo, Rajab M.; Noah, Patrick; Omutsani, Mary; Orloff, Lisa A.; Otiti, Jeffrey; Randolph, Gregory W.; Sebelik, Merry; Todsen, Tobias; Twier, Khaled; Fagan, Johannes J.; Otolaryngology -- Head and Neck Surgery, School of Medicine
Background International thyroid nodule and cancer management guidelines generally fail to take into account potential limitations in diagnostic and treatment resources. Methods Thyroid cancer specialists from the African Head and Neck Society and American Head & Neck Society Endocrine Section developed guidelines for diagnosis and management of thyroid nodules and cancer in low resource settings. Recommendations were based on literature review and expert opinion, with level of evidence defined. Results Using the ADAPTE process, diagnostic and treatment algorithms were adapted from the National Comprehensive Cancer Network (NCCN). Low resource settings were simulated by systematically removing elements such as availability of laboratory testing, hormone replacement, imaging, and cytopathology from NCCN guidelines. Conclusions Successful management of thyroid nodules and cancer in low resource settings requires adaptation of treatment methodologies. These guidelines define specific scenarios where either more or less aggressive intervention for thyroid pathology may be advisable based on limited available resources.
Anterolateral thigh osteomyocutaneous femur (ALTO) flap reconstruction for composite mandible and near total tongue defect utilizing a retrograde intramedullary femoral nail stabilization technique: Report of a first case
(Elsevier, 2020-06-01) Novinger, Leah J.; Cannady, Steven B.; Wurtz, Lawrence D.; Sim, Michael W.; Moore, Michael G.; Mantravadi, Avinash V.; Shipchandler, Taha Z.; Otolaryngology – Head and Neck Surgery, School of Medicine
The anterior lateral thigh osteomyocutaneous free flap (ALTO) offers the advantage of reconstructing large bony and soft tissue defects. We report a novel approach for femur stabilization via retrograde intramedullary nail placement in a patient with a near total tongue and large mandibular defect who underwent ALTO reconstruction that saves operating room time and decreases risk of post-operative fracture.
Concerns and Needs of Patients With Head and Neck Cancer in the COVID-19 Era
(Sage, 2021-07) Yan, Flora; Rauscher, Erika; Hollinger, Amanda; Caputo, Mary Ann; Ready, John; Nguyen, Shaun A.; Fakhry, Carole; Nathan, Cherie-Ann O.; Leonardis, Chris; Yearout, Danielle; Day, Terry A.; Moore, Michael G.; Otolaryngology -- Head and Neck Surgery, School of Medicine
Objective: To evaluate the concerns and needs of patients and survivors of head and neck cancer (HNC) in the COVID-19 era. Study Design: Prospective cross-sectional survey. Setting: Contact lists of 5 North American HNC advocacy groups. Methods: A 14-question survey was distributed to the contact lists of 5 HNC advocacy groups evaluating patient and survivor needs and concerns related to their cancer care and COVID-19. Results: There were 171 respondents, with 75% in the posttreatment period. The most common concern was contraction of COVID-19 (49%). More patients in active treatment preferred in-person visits than those in the early (≤5 years) and late (>5) survivorship period (72% vs 61% vs 40%, P < .001). A higher percentage of late survivors preferred virtual visits (38% vs 28%, P = .001). In total, 91 (53.2%) respondents sought emotional support outside of immediate family and friends. This included cancer support groups (36.2%), the medical team (29.7%), and other sources outside of these (34.1%), including faith-based organizations and online communities. A higher proportion of women than men (62% vs 41%, P = .001) were seeking emotional support outside of immediate family and friends. Conclusions: During the early stages of the COVID-19 pandemic, patients with HNC who were actively undergoing treatment had increased need for support resources and preferred in-person provider visits. Alternatively, a higher percentage of patients >5 years from treatment preferred virtual visits. Emotional support outside of family and friends was sought out by a majority of respondents. Further research is needed to determine what support and educational resources are needed to best aid these various populations.
Distribution of the head and neck surgical oncology workforce in the United States
(Wiley, 2022-11) Talwar, Abhinav; Gordon, Alex J.; Bewley, Arnaud F.; Fancy, Tanya; Lydiatt, William M.; Weed, Donald; Moore, Michael G.; Givi, Babak; Otolaryngology -- Head and Neck Surgery, School of Medicine
Background The recent trends in education and geographic distribution of the head and neck surgery workforce have not been studied extensively. Methods We reviewed publicly available sources to locate all fellowship-trained head and neck surgeons and recent graduates. The number of surgeons in each state was compared against head and neck cancer incidence data from the Centers for Disease Control. Results The number of graduates increased annually by 1 per 100 000 000 people from 2011–2020. The average number of fellowship-trained surgeons per state was 10 (SD: 12). The average number of new head and neck cancer cases per surgeon was 247 (SD: 135). Ten states (20%) had cases >1 SD above the national average/surgeon, while 3 (6%) had cases >1 SD below the national average. Conclusion Head and neck surgeons are located in most states, but not uniformly. Most states have approximately average density of surgeons; however, several states are outliers.
Droplet Exposure Risk to Providers From In-Office Flexible Laryngoscopy: A COVID-19 Simulation
(Sage, 2021-01) Ye, Michael J.; Sharma, Dhruv; Rubel, Kolin E.; Lebo, Nicole L.; Burgin, Sarah J.; Illing, Elisa A.; Ting, Jonathan Y.; Moore, Michael G.; Yesensky, Jessica A.; Mantravadi, Avinash V.; Sim, Michael W.; Otolaryngology -- Head and Neck Surgery, School of Medicine
To provide data on risk of respiratory droplets from common otolaryngologic procedures during the COVID-19 pandemic, a novel simulation of droplet exposure from flexible laryngoscopy was performed. After completion of a nasal symptom questionnaire, topical fluorescein spray was administered into the nasal and oropharynx of 10 healthy volunteers, who then underwent flexible laryngoscopy under 2 conditions: routine without provoked response and with prompted sneeze/cough. After each, droplets on the proceduralist and participant were counted under ultraviolet A light. Droplets were observed on 1 of 10 volunteers after routine laryngoscopy and 4 of 10 during laryngoscopy with sneeze/cough. A nasal symptom score based on congestion and rhinorrhea was significantly elevated among droplet producers after sneeze/cough (P = .0164). No droplets were observed on the provider. Overall, with adequate personal protective equipment, flexible laryngoscopy poses minimal droplet risk to providers. Nasal symptoms can identify patients more likely to produce droplets after sneeze/cough.
Flap demise reversed after central venous access device removal: A case report
(Wiley, 2020-05-25) Sandelski, Morgan M.; Rabbani, Cyrus C.; Moore, Michael G.; Sim, Michael W.; Medicine, School of Medicine
Patients undergoing head and neck free flap reconstruction should be evaluated for radiation‐induced venous stenosis and presence of central venous port as a potential risk for flap failure.

Browsing by Author "Moore, Michael G."

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