The results emphasize the need for early identification and treatment of depression in HNC patients, as well as the establishment of policies to routinely screen these patients throughout the cancer treatment process.

An mFI score of 3 or higher is associated with increased risk for postoperative complications, longer hospitalization, and need for postdischarge skilled care following total laryngectomy. The mFI provides a personalized risk assessment to better inform patients, physicians, and payers when planning a total laryngectomy.

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The objectives of the study were to compare characteristics of women and men discharged from an inpatient psychiatric facility and to identify gender-specific risk factors associated with 30-day and 1-year readmission using administrative data. The sample included adults discharged from an inpatient psychiatric facility in a Midwestern city (N = 1853). The analysis showed that the 30-day readmission rate was significantly lower among women, but there was no difference in the 1-year readmission rate. Risk factors for readmission differed by gender. For example, for 30-day readmission, being on Medicare versus commercial insurance increased the odds for women (OR 3.08; 95 % CI 1.35-7.04) and taking first-generation antipsychotics versus no antipsychotics increased the odds for men (OR 2.09; 95 % CI 1.26-3.48). These findings suggest there are important differences between women and men readmitted to an inpatient psychiatric facility. Future strategies need to take into account gender-specific risk factors in order to improve long-term patient outcomes.

Individuals experiencing chronic homelessness may utilize hospital services more frequently than the general population. Understanding the benefits of providing permanent supportive housing to these individuals can lead to improved services for this population. This study examined the effect of supportive housing placement on hospital admissions of adults who were homeless. Admissions were examined for a period of one-year pre- and postsupportive housing placement for 23 adults. Results showed a reduction in the number of emergency department admissions and an increase in outpatient admissions during the year following housing placement, indicating that supportive housing may encourage more appropriate use of health care services.

Resident participation in hemithyroidectomy may be associated with increased operative duration, higher incidence of wound complications, and readmission. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1212-1217, 2017.

Objectives To identify differences in postoperative wound complications associated with a primary tracheoesophageal puncture (TEP) at the time of laryngectomy versus no TEP. Study Design Retrospective review of large national data set. Setting Academic and nonacademic health care facilities in United States, contributing de-identified, risk-adjusted clinical data to the American College of Surgeons National Surgical Quality Improvement Program. Subjects and Methods The National Surgical Quality Improvement Program data set for years 2006 to 2012 identified 430 patients who underwent total laryngectomy with or without a primary TEP. Patients who underwent a TEP at the time of laryngectomy (n = 68) were compared with patients who underwent laryngectomy without a TEP (n = 362). Postoperative wound complications and secondary outcomes, including medical complications and length of hospitalization, were compared between the groups. Results The incidence of "superficial" and "deep or organ space" surgical site infection, medical complications, return to the operating room, and length of hospitalization were similar between the groups. Patients in the TEP group had a higher overall wound complication rate (relative risk, 2.02; 95% CI = 1.06-3.84; attributable risk, 8.17%; number needed to harm, 12). Conclusions Performance of a primary TEP concurrent to total laryngectomy contributed to a small increase in attributable risk for overall wound complications but did not add substantial risk for "superficial" or "deep or organ space" surgical site infection, medical complications, or increased burden for resource utilization. These data may help inform patient choice and physician recommendations for primary alaryngeal speech rehabilitation.

Being Treated for Head and Neck Cancer Trial (PROTECT) study group IMPORTANCE Patients with head and neck cancer (HNC) experience increased risk of depression and compromised quality of life. Identifying patients with HNC at risk of depression can help establish targeted interventions. OBJECTIVE To identify factors that may be associated with the development of moderate or severe depression during treatment of HNC. DESIGN, SETTING, AND PARTICIPANTS This is a retrospective, ad hoc, secondary analysis of prospectively collected data from a randomized, double-blind, placebo-controlled clinical trial. Patients were screened at academic-and community-based tertiary care HNC centers from January 2008 to December 2011. Of the 125 evaluable patients with stages II through IV HNC but without baseline depression, 60 were randomized to prophylactic antidepressant escitalopram oxalate and 65 to placebo at the time of the initial diagnosis. Data analyses were conducted from May 2016 to April 2017. MAIN OUTCOMES AND MEASURES Depression outcomes were measured using Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) scores (range, 0-27 with a score of 11 or higher indicative of moderate or greater depression). Factors that may be associated with development of moderate or severe depression were assessed, including patient demographics; cancer site and stage; primary treatment modality (surgery or radiotherapy); history of depression or other psychiatric diagnosis; previous treatment of depression or suicide attempt, family history of depression, suicide, or suicide attempt; and baseline score on the QIDS-SR and clinician-rated QIDS instruments. Participants were stratified by study site, sex, cancer stage (early [stage II] vs advanced [stage III or IV]), primary modality of treatment (radiotherapy with or without chemotherapy vs surgery with or without radiotherapy), and randomization to placebo or escitalopram and balanced within these strata. RESULTS The mean (SD) age of the 148 patients in the study population was 63.0 (11.9) years; 118 (79.7%) were men, and 143 (96.6%) were white. In the evaluable population of 125 patients, receiver operating characteristic analyses assessing the area under the curve for baseline QIDS-SR score (0.816; 95% CI, 0.696-0.935) and for initial radiotherapy-based treatment (0.681, 95% CI, 0.552-0.811) suggested that these 2 variables were associated with the likelihood of developing moderate or greater depression during the study period among patients who did not receive prophylactic antidepressants. The diagnostic sensitivity for identifying patients at risk of depression using the baseline QIDS-SR score improved to 100% at a threshold of 2 from 94% at a threshold of 4. CONCLUSIONS AND RELEVANCE Baseline symptoms and initial radiotherapy-based treatment may be associated with development of moderate or greater depression in patients with HNC. Patients with QIDS-SR baseline scores of 2 or higher may benefit the most from pharmacologic prophylaxis of depression.