IMPORTANCE Same-day Mohs reconstructive surgery is not always possible; moreover, a delay can offer benefits such as improved surgical planning and increased blood supply to the cauterized wound bed. However, recent work found that delaying reconstruction by more than 2 days increases the postoperative complication rate. OBJECTIVE To review the outcomes of Mohs micrographic surgery (MMS) reconstruction with respect to patient-and surgery-specific variables, especially timing of repair. DESIGN, SETTING, AND PARTICIPANTS Retrospective, single-institution cohort study of patients who underwent Mohs reconstructive surgery by 1 of the 2 senior authors from January 2012 to March 2017 for cutaneous squamous cell carcinoma or basal cell carcinoma. No patients had to be excluded for inadequate follow-up or incomplete medical records. MAIN OUTCOMES AND MEASURES Postoperative complications including hematoma, infection, dehiscence, and partial or full graft or flap loss. RESULTS A total of 633 defects in 591 patients (median [range] age, 65 [21-96] years; 333 [56.3%] female) were identified over the 5-year period. Reconstructions occurred from less than 24 hours to 32 days after MMS, with 229 (36.2%) delayed longer than 48 hours. Patient-specific variables reviewed included comorbidities, age, smoking status, and use of anticoagulant or antiplatelet medications. Surgery-specific variables analyzed included location and size of defect, time interval between MMS and reconstruction, and reconstructive modalities. Single-variable analysis was performed to determine whether each variable was associated with postoperative complications. On multivariable binary logistic regression, smoking status (odds ratio [OR], 2.46; 95% CI, 1.29-4.71; P = .007), defect size (OR exp(B), 1.04; 95% CI, 1.01-1.06; P = .006), full-thickness defects (OR, 1.56; 95% CI, 1.08-2.25; P = .02), interpolated flaps with cartilage grafting (OR, 8.09; 95% CI, 2.65-24.73; P < .001), and composite grafts (OR, 6.35; 95% CI, 2.25-17.92; P < .001) were associated with an increased risk of postoperative complications. CONCLUSIONS AND RELEVANCE We found no association between timing of Mohs reconstructive surgery and complications, indicating that a delayed repair did not increase the risk of infection or flap failure. Variables associated with an increased risk of postoperative complications include smoking status, size of the defect, full-thickness defects, interpolated flaps with cartilage grafting, and the use of composite grafts. LEVEL OF EVIDENCE 3.

Introduction Burn pits (BPs) have been widely used by the U.S. military for waste disposal while in conflicts abroad. Significant adverse health effects are thought to be linked to BPs, but limited data exist examining the impact on the respiratory tract. The purpose of this systematic review is to characterize these effects on both the upper respiratory tract (URT) and lower respiratory tract (LRT). Materials and Methods A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines on articles published from January 1, 2001, through November 2020. PubMed, EMBASE, and Ovid MEDLINE databases were queried for studies examining the effect of BPs on the URT and LRT of service members. Results A total of 288 articles were identified, with nine meeting inclusion criteria. Eight of the nine articles assessed the LRT, one examined the URT alone, and two examined both the URT and LRT. Outcome measures were heterogeneous across all studies, precluding meta-analysis. Patient-reported LRT diagnoses appeared to increase as exposure to BPs increased. There are very limited data assessing the impact of BP exposure on the URT. No association between BP exposure and objective measures of LRT or URT disease was identified. Conclusion Service members deployed to combat zones seem to report a significant increase in respiratory diseases following exposure to BPs, although definitive conclusions are limited by multiple airborne exposures and varied reporting methods. Self-reported LRT diagnoses appear to be more prevalent. There is a paucity of data on the effects of BPs on the URT. Objective measures of disease do not appear to correlate with patient reports. Prospective, long-term, and outcome-based studies are necessary to examine the effects of BPs, and other airborne hazards related to deployment, on the URT and LRT of service members.

Objectives/Hypothesis Tonsillectomy is one of the most common ambulatory surgeries performed in the United States, yet the incidence of post‐tonsillectomy hemorrhage (PTH) in adults remains unclear. In addition, any association between non‐steroidal anti‐inflammatory drugs (NSAIDs) and PTH in adults is currently unknown. The aim of this study is to examine the incidence and management of adult PTH at a single academic center and to assess for any association between NSAID use and PTH in adults. Study Design Retrospective chart review. Methods We conducted a retrospective chart review of adult tonsillectomies performed at our institution between January 1, 2012, and December 30, 2019. Demographics, past medical history, medications, NSAID use, surgical indication, bleeding events, and interventions were documented. The rate of PTH was calculated, logistic regression was performed to assess for any predictive factors, and odds ratios were calculated for NSAID use and PTH. Results A total of 1,057 adult tonsillectomies were performed within the aforementioned time period. A total of 126 patients experienced 163 bleeding events for a postoperative hemorrhage rate of 11.9%. Most were controlled with bedside interventions, while 29 (23%) bled more than once. The hemorrhage rate for those who were not prescribed NSAIDs postoperatively (n = 625) was 11.7%, compared to 12.6% for those who did receive NSAIDs postoperatively (n = 432), which was not significantly different (adjusted odds ratio 1.01, 95% confidence interval 0.69–1.49; P = .95). Conclusions This retrospective cohort study of 1,057 adult patients found the incidence of PTH to be 11.9%. This study found no association between the use of NSAIDs and the rate of PTH, although a higher‐powered study is needed. Level of Evidence 3 Laryngoscope, 132:949–953, 2022

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Hundreds of thousands of US Service Members have been exposed to deployment-related burn pits. This novel study demonstrates that individuals with burn pit exposure experience significantly worse quality of life and more severe objective sinus disease on exam, implying that this environmental exposure contributes to the development of chronic sinusitis.

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Dear Editor,We appreciate the points raised by Drs Onal and Onal for the opportunity to engage in collegial academic discussion. In their recent letter in reply to our publication Investigation of adult post-tonsillectomy hemorrhage rates and the impact on NSAID use, they astutely raise several points that warrant further discussion in regards to post-tonsillectomy hemorrhage.For those not familiar with our work, we had previously reported on 1057 adult tonsillectomies performed over a 7-year period, noting an 11.9% hemorrhage rate. Hemorrhage was intentionally liberally defined as any observation of blood that prompted an action on the part of the patient, from ER visit to return to OR. In addition, the bleeding rate of the 432 patients prescribed NSAIDs postoperatively was nearly identical to that of the 625 patients not prescribed NSAIDs (12.6% vs. 11.7%, adjusted OR 1.01). 1 Drs Onal and Onal note that we failed to include background data regarding the use of perioperative dexamethasone and ketorolac and this is true. However, between the authors' combined experience at this institution, which spans the years 2012-present, it is believed that nearly 100% of adult tonsillectomy patients have received dexamethasone preoperatively whereas we cannot recall one instance of ketorolac being administered. This was not verified with chart review and therefore must be taken with a grain of salt. Nonetheless, we do not believe that this omission would affect the primary outcomes of our study.An additional critique of our study was the failure to collect data on alcohol use from our patients' records. This is potentially a significant oversight given that concomitant alcohol use can potentiate the bleeding risk associated with NSAID use. However, we believe this to be a moot point. First of all, this potentiating effect requires that patients imbibe alcohol during the perioperative period, a time in which extreme postoperative throat pain often prevents PO intake to the point of dehydration. Writing about the increased risk of upper gastrointestinal bleeds with concomitant NSAID and alcohol use, Pfau and Lichtenstein state that the