Objective: The Risk Analysis Index (RAI) score is a screening tool to assess patient frailty. It has been shown to be predictive of postoperative outcomes and mortality in orthopedic, urologic, and neurosurgical patient populations. We sought to evaluate the predictive ability of RAI score for surgical outcomes in an otolaryngology patient population.Study Design: Retrospective study.Setting: Academic tertiary medical center.Methods: A retrospective study was conducted of adult patients undergoing otolaryngology surgery at a tertiary medical care center over 21 months. Patients were sent electronic RAI survey questionnaires via direct messaging, which was completed prior to surgery. Endpoint data were analyzed, including demographics, RAI score, and patient outcome data. Univariate analysis, ROC curves, and predictive modeling were utilized.Results: A total of 517 patients responded to the RAI questionnaire, resulting in a 59.6% response rate. Mean RAI score was 21.38 ± 11.83. Higher RAI scores were associated with increased 30‐day readmissions (P < .0015), postoperative complications (P < .001), hospital length of stay (P < .001), and discharge with home health (P < .001). Predictive models for RAI score and postoperative outcomes were created, and a cutoff score of RAI = 30 was established to identify frail patients.Conclusion: We evaluated if RAI scoring predicted postoperative complications in an otolaryngology patient population. Increased RAI score is significantly associated with poorer surgical outcomes, including increased hospital length of stay, 30‐day readmissions, and postoperative complications. We propose a predictive model with suggested RAI cutoff scoring for use in the otolaryngology surgical population.

Objective: The authors aim to demonstrate that the current drive-through testing model at a health district was improved in certain parameters compared with a previous testing protocol, and to provide the methodology of the current model for other coronavirus disease (COVID-19) testing sites to potentially emulate.Methods: Initially, a small drive-through site was constructed at a converted tuberculosis clinic, but due to an increase in testing needs, an expanded point of screening and testing (POST) system was developed in an event center parking lot to administer tests to a higher volume of patients.Results: An average of 51.1 patients was tested each day (2.0 tests per personnel in personal protective equipment [PPE] per hour) at the initial tuberculosis clinic drive-through site, which increased to 217.8 patients tested each day (5.9 tests per personnel in PPE per hour) with the new drive-through POST system (P < 0.001). Mean testing time was 3.4 minutes and the total time on-site averaged 14.4 minutes.Conclusions: This POST drive-through system serves as an efficient, safe, and adaptable model for high volume COVID-19 nasopharyngeal swabbing that the authors recommend other COVID-19 testing sites nationwide consider adopting for their own use.

Background: The aim of the study was to present a case of mixed olfactory neuroblastoma (ONB) and carcinoma, an extremely rare tumor with only a few cases in the published literature. Case Description: An otherwise healthy 27-year-old male presented with sinus complaints, headache, and unilateral eye discharge. Imaging and endoscopy revealed a mass presumed to represent a juvenile nasopharyngeal angiofibroma. Unexpectedly, the final pathology report revealed high grade mixed ONB and carcinoma. This tumor is the sixth and youngest documented patient with mixed ONB and carcinoma. Conclusion: Physicians should remain vigilant for the possibility of malignancy in their approach to nasal cavity masses, even in young otherwise healthy patients. Careful review of the immunohistopathology should also be taken, as mixed olfactory tumors such as these are aggressive, rare entities that require multidisciplinary oncologic care.

Tracheal perforation is an extremely rare and potentially dangerous complication of a partial thyroidectomy. The current case represents a unique presentation of delayed tracheal perforation following an uncomplicated thyroid isthmusectomy for tissue diagnosis of an aggressive appearing thyroid mass in the setting of high-dose steroid administration and recent intubation and self-extubation. While conservative management of tracheal perforation can sometimes be appropriate, our patient was successfully managed via primary closure and infrahyoid muscle transposition flap to cover a 5 mm right lateral tracheal wall defect. We recommend caution be exercised following thyroid surgery in the setting of intubation and high-dose steroids.

Objectives: Anaplastic thyroid cancer (ATC) is the most aggressive and fatal thyroid malignancy. Currently, there still exists a paucity of literature studying the relationship between available ATC‐targeted therapy, immunotherapy, and survival. We aim to investigate how systemic therapies affect survival outcomes in ATC.Methods: A single‐tertiary‐institution chart review of patients diagnosed with advanced‐stage ATC, and who underwent surgery as part of their treatment, was performed between 2000 and 2023, with 41 patients included. Demographics, clinical characteristics, and survival data were collected and analyzed via Kaplan–Meier and Cox proportional hazards analyses.Results: 54% of patients were female, and average age was 67.4 years old. The most common mutations identified were BRAF (15 patients), p53 (9 patients), and p63 (2 patients). A total of 18 patients utilized targeted or immunotherapy, with Trametinib and Dabrafenib (9 patients) as the most common agents used. Two‐year overall survival was 24%, and 5‐year overall survival was 23%, with median survival time of 7.6 months. Kaplan–Meier analysis demonstrated improved survival in patients who received chemotherapy (p = 0.048). Cox proportional hazards analysis demonstrated that patients treated with immunotherapy or targeted therapy had a statistically significant increase in survival compared with patients who did not receive these therapies (p = 0.016). Additionally, females and those with a p63 mutation demonstrated improved survival outcomes (p = 0.010, p = 0.001).Conclusions: Targeted therapy and immunotherapy use should be strongly considered when treating patients with ATC. Further studies into novel drugs targeting immune checkpoints and combination therapy are needed to better optimize treatment of patients with ATC.Level of Evidence: 3 Laryngoscope, 2024