Objectives Subglottic stenosis can be addressed with several different surgical techniques, but patient preferences for these treatment modalities are poorly understood. Economic methods are increasingly being used to understand how patients make decisions. The objective of this pilot study was to assess preferences in subglottic stenosis treatment using patient-centric stated preference techniques. Study Design Discrete choice experiment (DCE). Setting Academic research facility. Subjects and Methods A computer-based DCE was administered in a monitored setting to volunteers from the general population. Signs and symptoms of subglottic stenosis were described, and participants were asked to imagine they had subglottic stenosis. Hypothetical treatments were offered, with 5 systematically varied attributes: need for external incision, length of hospital stay, postoperative voice quality, likelihood of repeat procedures, and risk of complication. A conditional logistic model was used to assess the relative attribute importance. Results In total, 162 participants were included. Attributes with the greatest impact on decision making included potential need for repeat procedures (importance 30.2%; P < .001), amount of operative risk (importance 28.1%; P < .001), and postoperative voice quality (importance 27.7%; P < .001), whereas presence of incision (importance 5.0%; P = .001) was less important, and hospital stay was not (importance 9.0%; P = .089). Based on aggregate responses for these attributes, the model demonstrated that most participants (80.4%) would prefer endoscopic surgery for subglottic stenosis as opposed to open tracheal resection (19.6%). Conclusion In this pilot population, most participants preferred voice-sparing, low-risk procedures as treatment for subglottic stenosis, consistent with an endoscopic approach, even if multiple procedures were required.

Objectives Patient preferences are crucial for the delivery of patient-centered care. Discrete choice experiments (DCEs) are an emerging quantitative methodology used for understanding these preferences. In this study, we employed DCE techniques to understand the preferences of patients presenting for an ear, nose, and throat clinic visit. Study Design DCE. Setting Decision science laboratory. Methods A DCE survey of 5 attributes-wait time, physician experience, physician personality, utilization of visit time, and cost/copayment-was constructed with structured qualitative interviews with patients. The DCE was administered to participants from the general population, who chose among hypothetical scenarios that varied across these attributes. A conditional logit model was used to determine relative attribute importance, with a separate logit model for determining subject effects. Results A total of 161 participants were included. Cost/copayment had the greatest impact on decision making (importance, 32.2%), followed by wait time and physician experience (26.5% and 24.7%, respectively). Physician personality mattered least (4.7%), although all attributes were significantly correlated to decision making. Participants preferred doctors who spent more time performing physical examination than listening or explaining. Participants were willing to pay $52 extra to avoid a 4-week delay in appointment time; $87 extra for a physician with 10 years of experience (vs 0 years); and $9 extra for a caring, friendly, and compassionate doctor (vs formal, efficient, and business-like). Conclusion DCEs allow for powerful economic analyses that may help physicians understand patient preferences. Our model showed that cost is an important factor to patients and that patients are willing to pay extra for timely appointments, experience, and thorough physical examination.

Relatively few true pharyngoceles have been reported in the surgical literature. We offer the first detailed endoscopic anatomic description and formal evaluation of swallowing outcomes, as well as an anatomically-based endoscopic approach. These lesions may be amenable to endoscopic repair with minimal long-term morbidity.

POSTERS and T-closure methods, by evaluating the rates of pharyngocutaneous fistulas (PCFs) and dysphagia postoperatively. Method: Retrospective analysis of postoperative complications associated with horizontal pharyngeal closure during total laryngectomies at a tertiary institution from 2007 to 2011. Chart reviews were performed on a total of 15 total laryngectomy patients with horizontal pharyngeal closure, evaluating for fistula formation and dysphagia compared to reported rates in the literature. Results: Twenty percent (3/15) of patients developed postoperative PCFs, and 18% (2/11) with dysphagia. Patients that had not been tried on oral feeds due to wound complications or those with recurrent disease were excluded for evaluating dysphagia. Conclusion: A literature search revealed no studies evaluating horizontal pharyngeal closure. Reported ranges of PCFs are 13% to 25%, with dysphagia 17% to 70%. This study shows PCFs and dysphagia rates within these ranges. Thus, horizontal pharyngeal closure appears to be a viable alternative to T and vertical closures.

Spontaneous hematoma within the iliopsoas muscle (SIH) is a rare complication most commonly seen in coagulopathic patients. Often, patients undergoing microvascular free tissue transfer are anticoagulated for anastomotic patency. Here we describe two cases of postoperative SIH following contralateral anterolateral thigh (ALT) free tissue transfer for reconstruction of oncologic head and neck defects. Both patients described hip pain after mobilization and had a corresponding acute blood loss anemia. Diagnosis of SIH was confirmed by CT and both patients were managed conservatively. Given that anticoagulation is a common practice following head and neck free tissue transfer, surgeons should be aware of this potential complication.