Academic Otolaryngology Research Articles

Effect of a Documentation Improvement Program for an Academic Otolaryngology Practice.

Physicians recognize the value of accurate documentation to facilitate patient care, communication, and the distribution of professional fees. However, the association between inpatient documentation, hospital billing, and quality metrics is less clear. To identify areas of deficiency in inpatient documentation and to instruct health care professionals on how to improve the quality and accuracy of clinical records. A single-arm pre-post study was conducted from January 1, 2013, to December 31, 2014, among 17 attending and 12 resident physicians treating 1188 patients at an academic medical center. Data from 1 year prior to the intervention were compared with data for 10 months following the intervention. All increases were analyzed as a percentage increase after the intervention relative to before the intervention. Areas for improvement were identified, and all physicians in the department received education on inpatient coding and documentation. The capture rate for complications or comorbidities and major complications or comorbidities, the case mix index (the average diagnosis related group relative weight for a hospital or department), and severity of illness and risk of mortality scores. A total of 1188 inpatients were included in the analysis: 743 in the preintervention period and 445 in the postintervention period. Review of our documentation identified major areas of comorbidity that were frequently underreported. Inadequate nutrition diagnoses (moderate malnutrition, severe protein-calorie malnutrition) were most often underreported. In addition, we found inadequate documentation supporting the presence of neck metastases. Among 1188 patients, the case mix index increased 5.3% (from 2.81 to 2.96) after the intervention, but this was not a statistically significant difference (P = .21). The normalized case mix index increased 21.7% (from 37.3 to 45.4; P < .01). The percentage of patients with a documented complication or comorbidity or major complication or comorbidity increased 27.1% (from 50.2% to 63.8%; P < .01). The percentage of patients assigned a severity of illness score of 3 or 4 increased 24.3% (from 34.7% to 43.0%; P < .01). The percentage of patients assigned a risk of mortality score of 3 or 4 increased 32.1% (from 18.7% to 24.7%; P = .01). After educational sessions, multiple measures of patient acuity increased significantly owing to improved documentation of common comorbid conditions. Although physicians intuitively appreciate the importance of good documentation, education on the technical aspects of coding can significantly improve the quality and accuracy of clinical records.

Association of Fellowship Training With Otolaryngology Training Examination Scores

No prior studies have evaluated whether residents who pursue fellowship training achieve higher performance on the Otolaryngology Training Examination (OTE) and whether a specific fellowship will demonstrate a correlation with the corresponding specialty-specific OTE score. To determine whether residents pursuing fellowship training achieve higher performance on the OTE and whether fellowship choice is correlated with higher scores on the related subspecialty section of the OTE. This retrospective analysis included 35 residents training in an academic otolaryngology residency program from July 1, 2003, to June 30, 2014. The OTE scores for postgraduate years 2 through 5 and the type of fellowship were collected for all residents meeting inclusion criteria. Data were collected from September 1 to October 15, 2014, and analyzed from October 16 to December 1, 2014. Residents were divided by whether they pursued fellowship training and by the type of fellowship chosen. Outcome measures included comparison of scores between residents who pursued vs those who did not pursue fellowship training and comparison of subspecialty OTE scores between residents who pursued the corresponding fellowship and those who did not. Of the 35 residents who met the inclusion criteria (24 men and 11 women), 17 (49%) pursued fellowship training. The 3 most common fellowship choices were facial plastic and reconstructive surgery, pediatric otolaryngology, and rhinology (4 residents each [24%]). For all residents, mean scores on the OTE improved each subsequent training year, but this difference was only significant between postgraduate years 2 and 3 (from 60.9% to 68.6% correct; P < .001). Residents who pursued fellowship training did not perform better than those who did not (mean correct responses in postgraduate years 2-5, respectively, 59.6% vs 62.6% [P = .40]; 67.6% vs 71.2% [P = .33]; 71.2% vs 72.0% [P = .71]; and 71.4% vs 73.7% [P = .20]). Among residents who pursued the most common fellowships, no correlation was found between postgraduate year 5 scores on the related subspecialty section compared with the rest of the study group (mean correct responses for facial plastic and reconstructive surgery, 72.5% vs 74.7% [P = .67]; for pediatric otolaryngology, 72.9% vs 71.3% [P = .79]; and for rhinology, 72.2% vs 71.2% [P = .91]). Residents who pursued fellowship training did not achieve higher scores on the OTE in any examination year compared with residents who did not pursue fellowship training and did not achieve higher scores within the OTE section that matched their chosen subspecialty in their last year of training. Fellowship choice does not appear to influence OTE scores among residents.

Variability of Ratings in the Otolaryngology Standardized Letter of Recommendation.

To determine the variability of ratings given to students on the otolaryngology standardized letter of recommendation (SLOR). Retrospective review. Academic otolaryngology training program. 496 SLORs to the Cleveland Clinic Otolaryngology Training Program were reviewed. The SLORs were extracted from the applications and analyzed. The distributions of ratings across the 10 categories were statistically analyzed including distribution and standard deviation. Rankings were grouped into deciles for this analysis. Ratings across the 10 domains revealed clustering of results across the top 2 deciles. The distribution of the bell-shaped curve was shifted significantly to the left, representing the upper deciles. No evidence of gender or geographic bias was found. Longer length of time of association between the applicant and the letter writer correlated to a higher ranking. The explosion of applications being sent out by candidates for otolaryngology residency programs has prompted the implementation of the SLOR. The lack of variation in the ratings across the 10 domains does not allow for differentiation among student applicants. Reliance on the narrative letter of recommendation attached to the SLOR still remains the most significant way to differentiate among applicants. Refinements will need to be made in either the structure or use of the SLOR for it to be a more useful tool.

Status and trends of general otolaryngology in academia.

This article focuses on the hiring trends of academic general otolaryngology practices to clarify the status of academic general otolaryngology in the face of today's changing medical landscape. Cross-sectional study. We conducted a survey to evaluate past, present, and projected hiring issues in academic otolaryngology, specifically related to general otolaryngology. Surveys were sent via e-mail to all academic chairpersons of accredited otolaryngology residency programs in the United States. Data included faculty appointments, work hours, clinical and research roles, academic productivity, patient load, promotions, and criteria for future hires. The response rate was 34.3%. On average, general otolaryngologists (generalists) represented 17% of otolaryngology faculty in academic practices. Whereas most generalists were employed as assistant professors (65%), nearly half of promotions in recent years were given to generalists (49%). Between 2009 and 2014, there was an average of six new hires per academic otolaryngology practice (range: 1-13); of these new hires, 21% were generalists. Chairpersons estimated that in the next 5 years they would hire an average of three new otolaryngologists per practice (range: 0-7), of whom 39% would be generalists. Although 82% of chairpersons reported an increase in subspecialty hires, 94% reported that they would also require the same or increasing numbers of generalists. Despite the increase in subspecialization in academic otolaryngology, the role of general otolaryngologists in academic practices will continue to be important and perhaps will increase. N/A. Laryngoscope, 126:1995-1998, 2016.

An Athymic Rat Model for Mandibular Osteoradionecrosis Allowing for Direct Translation of Regenerative Treatments

We aim to create a model of mandibular osteoradionecrosis in athymic rats. Athymic rats provide an immunosuppressed environment whereby human stem cells and biomaterials can be used to investigate regenerative solutions for osteoradionecrosis, bridging the gap between in vivo testing and clinical application. Prospective animal study. Academic otolaryngology department laboratory. After Institutional Animal Care and Use Committee approval, 10 athymic nude rats were divided into 2 groups. The experimental group (n = 6) underwent irradiation (20 Gy), while the control group (n = 4) underwent sham irradiation catheter placement only. All 10 rats underwent extraction of the second mandibular molar 7 days later. The rats were sacrificed 28 days after dental extraction, and their mandibles were harvested. The mandibles were examined with histologic analysis and bone volume analysis based on 3-dimensional micro-computed tomography. All 10 rats survived the experiment period. Radiographic and histologic analysis revealed decreased bone formation in the experimental group compared with the control group. Jaw region volume ratio was 0.83 for the experimental group versus 0.97 in the control group (P = .003). The region-of-interest volume ratio was 0.75 in the experimental group and 0.97 in the control group (P = .005). Histologically, there were increased osteoclasts (P = .02) and decreased osteoblasts (P = .001) as well as increased fibrosis in the experimental group versus the control group. Mandibular osteoradionecrosis can be effectively and reproducibly produced in an athymic rat model. This will allow further research to study regenerative medicine in an athymic rat model.

Faculty diversity and inclusion program outcomes at an academic otolaryngology department.

To describe a 10-year diversity initiative to increase the number of women and underrepresented minorities in an academic department of otolaryngology-head and neck surgery. Retrospective review. A multifaceted approach was undertaken to recruit and retain women and underrepresented minority (URM) faculty: creation of a climate of diversity, aggressive recruitment, achievement of parity of salary at rank regardless of gender or minority status, provision of mentorship to women and URM faculty, and increasing the pipeline of qualified candidates. Primary outcomes measures included number of women and URM faculty, academic rank, and salary. From 2004 to 2014, the percentage of women clinical faculty increased from 5.8% to 23.7%; women basic science faculty increased from 11.1% to 37.5%. The number of women at associate professor rank increased from 0 to eight. During this period, underrepresented minority faculty increased in number from two to four; URM full professors increased in number from 0 to 1. In 2004, women earned 4% to 12% less than their male counterparts; there were no salary differences for URM. In 2014, salary was equal by rank and subspecialty training independent of gender or minority status. A comprehensive diversity and inclusion initiative has increased representation of women and URM faculty in an academic department of otolaryngology-head and neck surgery. However, there continue to be opportunities to further increase diversity. N/A.

Practice arrangement and medicare physician payment in otolaryngology.

Medicare Part B physician payment indicates a cost to Medicare beneficiaries for a physician service and connotes physician clinical productivity. The objective of this study was to determine whether there was an association between practice arrangement and Medicare physician payment. Cross-sectional study. Medicare provider utilization and payment data. Otolaryngologists from 1 metropolitan area were included as part of a pilot study. A generalized linear model was used to determine the effect of practice-specific variables including patient volumes on physician payment. Of 67 otolaryngologists included, 23 (34%) provided services through an independent practice, while others were employed by 1 of 3 local academic centers. Median payment was $58,895 per physician for the year, although some physicians received substantially higher payments. Reimbursements to faculty at 1 academic department were higher than to those at other institutions or to independent practitioners. After adjustments were made for patient volumes, physician subspecialty, and gender, payments to each faculty at Hospital C were 2 times higher than to those at Hospital A (relative ratio [RR] 2.03; 95% CI, 1.27-3.27; P = .003); 2 times higher than to faculty at Hospital B (RR 2.04; 95% CI, 1.4-2.7; P = .0001); and 1.6 times higher than to independent practitioners (RR 1.6; 95% CI, 1.04-2.7; P = .03). Payments to physicians in the other groups were not significantly different. Differences in reimbursement corresponded to an emphasis on procedures over office visits but not Medicare case mix adjustments for patient discharges from associated institutions. Variation in the cost of academic otolaryngology care may be subject in part to institutional factors.

Time to competency, reliability of flexible transnasal laryngoscopy by training level: a pilot study.

To determine the progression of flexible transnasal laryngoscopy reliability and competency in otolaryngology residency training. Prospective case control study. Academic otolaryngology department. Medical students, otolaryngology residents, and otolaryngology attending physicians. Fourteen otolaryngology residents from PGY-1 to PGY-5 and 3 attending otolaryngologists viewed 25 selected and digitally recorded flexible transnasal laryngoscopies. The evaluators were asked to rate 13 items relating to abnormalities in the oropharynx, hypopharynx, larynx, and subglottis. The level of concern and level of comfort with the diagnosis were assessed. Intraclass correlations were calculated for each topic and by level of training to determine reliability within each class and compare competency versus attending interpretations. Intraclass correlation of residents compared to attending physicians demonstrated significant improvements by year for left and right vocal fold immobility, subglottic stenosis, laryngeal mass, left and right vocal cord abnormalities, and level of concern. Additionally, pooled vocal cord mobility and pooled results in categories with good attending reliability demonstrated stepwise improvement as well. For these categories, resident reliability was found to be statistically similar to attending physicians in all categories by PGY-3. There were no trends for base of tongue abnormalities, pharyngeal abnormalities, and pharyngeal and hypopharyngeal masses. Resident competency for flexible transnasal laryngoscopy progresses during residency to reliability with attending otolaryngologists by the PGY-3 year over key facets of the examination.

Academic Benchmarks for Otolaryngology Leaders.

This study aimed to characterize current benchmarks for academic otolaryngologists serving in positions of leadership and identify factors potentially associated with promotion to these positions. Information regarding chairs (or division chiefs), vice chairs, and residency program directors was obtained from faculty listings and organized by degree(s) obtained, academic rank, fellowship training status, sex, and experience. Research productivity was characterized by (a) successful procurement of active grants from the National Institutes of Health and prior grants from the American Academy of Otolaryngology-Head and Neck Surgery Foundation Centralized Otolaryngology Research Efforts program and (b) scholarly impact, as measured by the h-index. Chairs had the greatest amount of experience (32.4 years) and were the least likely to have multiple degrees, with 75.8% having an MD degree only. Program directors were the most likely to be fellowship trained (84.8%). Women represented 16% of program directors, 3% of chairs, and no vice chairs. Chairs had the highest scholarly impact (as measured by the h-index) and the greatest external grant funding. This analysis characterizes the current picture of leadership in academic otolaryngology. Chairs, when compared to their vice chair and program director counterparts, had more experience and greater research impact. Women were poorly represented among all academic leadership positions.

Developing Theory-Based Measurement Tools for Improving Diet Compliance in Head and Neck Cancer Patients

Developing Theory-Based Measurement Tools for Improving Diet Compliance in Head and Neck Cancer Patients Increasing compliance with diet recommendations is critical for improving health, quality of life, and survival among head and neck cancer (HNCa) patients. The social cognitive theory is a potentially useful behavioral theory framework for improving compliance but measurement tools assessing theory constructs related to diet compliance in HNCa patients are needed. Therefore, our study aim was to pilot test social cognitive theory construct measures, including prevalence and preliminary associations with self-reported compliance with physician or dietitian diet recommendations.Cross-sectional survey completed by 33 HNCa patients followed in an out-patient academic otolaryngology clinic.T

A smartphone-optimized web site for conveniently viewing otolaryngology journal abstracts.

Access to the medical literature has not kept pace with the mobile revolution. We aimed to (1) gauge interest in a smartphone-optimized Web site for conveniently accessing otolaryngology literature and (2) create an easy-to-access and convenient Web site that displays otolaryngology journal abstracts in a format optimized for smartphones. A survey was sent to physicians of a major US academic otolaryngology-head and neck surgery department. Demographics, literature-browsing habits, and barriers to staying updated were assessed. The response rate was 87%. Ninety-one percent of respondents used a smartphone, and 85% wished they could stay more up to date with the otolaryngology literature. Most respondents believed a convenient smartphone-optimized Web site could help them achieve this goal. A Web site was then developed in collaboration with a university creative department as a proof of concept. The site uses a simple RSS aggregator to display journal abstracts formatted for smartphone-sized screens (www.otosurg.com).

The Impact of Physician Extenders in an Academic Otolaryngology Residency Program: Initial Experiences

Objectives: A physician extender is a licensed health care provider who performs medical activities typically performed by a physician. The term encompasses highly trained health care professionals such as physician assistants, nurse practitioners, and midlevel practitioners. In our academic, tertiary care otolaryngology residency-training program, a physician extender was recently hired. The objective of this study was to evaluate his impact on resident quality of life and education as well as his productivity. Methods: All otolaryngology residents at an academic tertiary care medical center were issued a questionnaire that they answered anonymously. All inpatient consults seen by the physician extenders and residents over an 18-month period between June 2012 and December 2013 were prospectively captured and evaluated. Results: The results of the survey indicated that all residents unanimously agreed that a physician extender had a positive impact on resident education, patient care, and quality of life. There was no statistically significant difference in the types of consults seen by a physician extender and those seen by a resident. The physician extender enhanced departmental productivity on the inpatient consultation service. Conclusions: Physician extenders are valuable assets to academic otolaryngology residency programs. Their presence enhances patient access, care, and departmental productivity. They have a positive impact on resident quality of life and augment resident education.

Laryngeal Manipulation for Dysphagia from Muscle Tension Dysphonia

Objectives: (1) Appreciate the use of laryngeal manipulation as treatment for perceived dysphagia resulting from excessive paralaryngeal muscle tension. (2) Describe the patients likely to have symptomatic improvement. Methods: A retrospective review identified patients from 2007-2011 with laryngeal manipulation for muscle tension-caused dysphagia in an academic otolaryngology practice. Subjects with dysphagia not attributable to anatomic cause who attended therapy twice or more had symptoms, demographic information, treatment, and response to therapy abstracted. Results: Thirty-five subjects were included, consisting of 28 women and 7 men. Race was recorded as black (11), Hispanic (8), white (9), and other (7). Improvement in dysphagia was seen in 25 (71.4%, 95% confidence interval 53.7% to 86.4%). No significant differences were seen in improvement based on sex ( P = .381) or race ( P = .439) in chi-square testing. The combination of age and number of sessions were predictive of improvement ( P = .041) but were not individually significant (age P = .096, sessions P = .084) using logistic regression. Conclusions: We found improvement with laryngeal manipulation among individuals with muscle-tension-caused dysphagia. No significant differences in efficacy were seen among racial and sex subgroups. A model with age and number of sessions was significant. A prospective trial of this therapy appears warranted.

Nasal Mucus Glucose and Chronic Rhinosinusitis

Objectives: Respiratory secretion glucose concentration is tightly regulated and contributes to airway innate immunity. Thus, we set out to quantify nasal mucus glucose concentration in chronic rhinosinusitis (CRS) patients and correlate these values to CRS symptoms. Methods: Prospective, single-center study measuring nasal mucus glucose concentration in patients diagnosed with chronic rhinosinusitis and age/race matched controls from July 1, 2013, to January 1, 2014. Enrollment included subjects &gt;18 years of age evaluated in academic otolaryngology practice. Subjects completed questionnaires including extensive history of medical and surgical therapies as well as CRS-specific quality of life measurements (SNOT-22). Subjects underwent nasal secretion sampling with sterilized Pope ear wicks. The nasal glucose concentrations of controls and subjects were analyzed with multivariate analysis to assess for confounding variables including systemic and topical glucocorticoid treatment. Results: Ninety-five patients enrolled, and 3 patients were excluded because of history of sinonasal radiation. A statistically significant difference was measured between mean nasal glucose secretions of control subjects, 11.1 mg/dL (±1.0 mg/dL), compared to patients diagnosed with CRS, 18.4 mg/dL (±1.6 mg/dL) ( P &lt; .01). No significant correlation was evident comparing nasal glucose concentrations to SNOT-22 nor use of glucocorticoid (topical or systemic) therapy. Conclusions: CRS patients demonstrate elevated nasal glucose concentrations independent of therapeutic glucocorticoid use. However, nasal mucus glucose concentrations do not appear to correlate to CRS symptoms. The role of nasal mucus glucose concentrations in CRS pathophysiology has yet to be determined.

Bridging the Generation Gap: The Reality of EMR Implementation

Objectives: Assess the attitude of academic otolaryngology faculty members toward a new electronic medical record (EMR) and determine the impact of implementation on their perspectives. Methods: A longitudinal survey study was conducted from December 2013 to June 2013 at an academic medical center. All otolaryngology and audiology faculty members were serially administered an online, 10-question survey assessing their attitudes toward implementation of a new EMR system. These surveys were completed 3 months prior and 1 and 3 months after implementation. Basic demographic information was also collected. Results: Thirty faculty members completed all 3 surveys. Compared with respondents over 40 years old, those under 40 years reported being more comfortable with computers ( P = .035). Prior to implementation, respondents under 40 years were statistically more likely to believe that the new EMR documentation would be both more efficient ( P = .018) and higher quality ( P = .030). However, by the end of the study the attitudes of the groups had converged; those under 40 years were less positive about the efficiency and quality of documentation in the new system and those over 40 years had become more enthusiastic about these aspects of EMR documentation. Conclusions: Younger faculty members appear to be more comfortable with the use of computers. This possibly led them to be more optimistic about the potential benefits of the EMR system. However, implementation appeared to alter both age cohorts’ perspectives, with younger faculty becoming less positive and older faculty becoming more enthusiastic about the EMR’s impact.

Improving Patient Satisfaction in the Outpatient Otolaryngology Clinic

Objectives: (1) Determine patient and provider factors associated with patient dissatisfaction in an otolaryngology clinic. (2) Identify strategies to improve the patient experience. Methods: Patient satisfaction surveys were prospectively collected in an academic otolaryngology clinic from January 2011 through March 2013. Patient variables (age, insurance type, established vs new patient, diagnosis, and treatability of condition) and provider variables (years in practice, subspecialty, and clinic wait time) were retrospectively analyzed to determine factors associated with patient dissatisfaction. “Treatability” was graded on a scale of 1 to 5, with diagnoses having a clear treatment option (ie, tonsillectomy for chronic tonsillitis) = 1, and diagnoses with no therapeutic options available (ie, tinnitus) = 5. Results: The cohort included 820 patient satisfaction surveys and charts. Stepwise linear regression analysis identified no single patient or provider variable associated with poor satisfaction scores. Cluster analysis evaluating the interplay between variables identified 5 unique clusters of patients. Satisfaction scores in 4 of the clusters were in the 99th percentile, while the remaining cluster ranked in the 10th percentile. This cluster consisted of a higher proportion of new patients with difficult-to-treat otologic conditions who described their wait time as excessive and were more likely to be self-pay. Conclusions: Several factors influence patient satisfaction in an otolaryngology clinic. In this study, variables associated with lower patient satisfaction scores included patients with longer clinic wait times, “difficult to treat” otologic diagnoses, and new patients. Addressing the issues common in this population to better meet their needs and expectations may improve overall patient satisfaction.

Clinical and pathologic characteristics of intranasal abuse of combined opioid-acetaminophen medications.

The nonmedical abuse of prescription opioids via intranasal administration is a growing problem. The objective of this study is to investigate of the typical presentation of intranasal opioid-acetaminophen abuse and outline optimal therapy. This study was a retrospective chart review. Patients with intranasal pathology from inhalation of combined opioid-acetaminophen medications (COAMs) from 3 academic otolaryngology practices in western Pennsylvania from January 2012 to October 2012 were included in the review. Seven adults ranging in age from 23 to 46 years were identified with nasal complaints from the intranasal inhalation of COAMs. All patients presented with nasal pain and were found to have fibrinous necrotic nasal mucosa involving the posterior nasal cavity and nasopharynx. Of the 7 patients, 6 (85.7%) presented with a septal perforation. Pathology and culture revealed fungus in 85.7% of the patients; however, no invasive fungal disease was noted in any of the specimens. Patients did not improve with either systemic or topical antifungal therapy. Polarizable material characteristic of talc used as a tablet binder was present in the histopathology of 4 of 7 (57.1%) patients. Patients who abstained from intranasal drug use along with serial debridement demonstrated the greatest improvement. Intranasal COAM abuse causes nasal pain, tissue necrosis with potential septal and palatal perforation, and noninvasive fungal colonization. Antifungal therapy was of no benefit in the current series of patients. Current therapy should focus on recognition of the etiology of patients' pathology and encourage abstinence from intranasal use of these drugs along with serial debridements.

Still under the microscope: can a surgical aptitude test predict otolaryngology resident performance?

Application to otolaryngology-head and neck surgery residency is highly competitive, and the interview process strives to select qualified applicants with a high aptitude for the specialty. Commonly employed criteria for applicant selection have failed to show correlation with proficiency during residency training. We evaluate the correlation between the results of a surgical aptitude test administered to otolaryngology resident applicants and their performance during residency. Retrospective study at an academic otolaryngology-head and neck surgery residency program. Between 2007 and 2013, 224 resident applicants participated in a previously described surgical aptitude test administered at a microvascular surgical station. The composite score and attitudinal scores for 24 consecutive residents who matched at our institution were recorded, and their residency performance was analyzed by faculty survey on a five-point scale. The composite and attitudinal scores were analyzed for correlation with residency performance score by regression analysis. Twenty-four residents were evaluated for overall quality as a clinician by eight faculty members who were blinded to the results of surgical aptitude testing. The results of these surveys showed good inter-rater reliability. Both the overall aptitude test scores and the subset attitudinal score showed reliability in predicting performance during residency training. The goal of the residency selection process is to evaluate the candidate's potential for success in residency and beyond. The results of this study suggest that a simple-to-administer clinical skills test may have predictive value for success in residency and clinician quality. 4.

Venous thromboembolism in otolaryngology surgical inpatients receiving chemoprophylaxis

The Caprini risk assessment model for stratifying patients' risk for venous thromboembolism (VTE) has been validated in the otolaryngology literature. We sought to determine the incidence of VTE in patients receiving chemoprophylaxis and correlate with the Caprini risk assessment model. A retrospective chart review of adult surgical admissions to an academic otolaryngology service from 2007 to 2012 was performed. Caprini risk assessment model scores were calculated and compared to incidence of VTE based on diagnosis codes. Seven hundred four patients met our inclusion criteria. Fifteen (2.13%) developed VTE. The Caprini risk assessment model score averaged 5.7 (range, 2-16). Patients with VTE had an average score of 9.87 versus 5.62 for those without (p < .0001). No patients with a score of 6 and below, 3.01% with 7-8, and 13.16% with a score >9 developed VTE. The incidence of VTE increases with Caprini risk assessment model score, and a score of >8 predicts a high risk (>13%) of VTE in postoperative otolaryngology inpatients despite chemoprophylaxis.

Regional Differences in Gender Promotion and Scholarly Productivity

Objectives: Identify whether there are regional differences in previously described gender disparities in scholarly productivity and faculty rank among academic otolaryngologists. Methods: Online faculty listings from 95 academic otolaryngology departments were searched to identify clinical faculty and further organize them by gender, academic rank, fellowship training status, and institutional location. The Scopus database was used to assess various bibliometrics of these otolaryngologists, including the h-index, number of publications, and publication range (in years). Results: Analysis included 1,127 otolaryngologists, 916 men (81.3%) and 211 women (18.7%). Female faculty comprised 15.4% in the Midwest, 18.8% in the Northeast, 21.3% in the South, and 19.0% in the West (p=0.44). Overall, men obtained significantly higher senior academic ranks (Associate Professor or Professor) compared to women (59.8% vs. 40.2%, p&lt;0.0001). Regional gender differences among senior faculty were found in the South (59.8% men vs. 37.3% women, p=0.0003) and in the Northeast (56.4% men vs. 24.1% women, p&lt;0.0001) with concomitant gender differences in scholarly impact, as measured by the h-index (South, p=0.0003; Northeast, p=0.0001). Among geographic subdivisions, female representation at senior ranks was lowest in the Mid-Atlantic (21.9%), New England (17.1%), and West South Central (33.3%), while highest in the Pacific (60.0%) and Mountain (71.4%) regions. No regional gender differences were found in fellowship training patterns (p-values&gt;0.05). Conclusions: Gender disparities in academic rank and scholarly productivity exist regionally, most notably in the Northeast where women in otolaryngology are most underrepresented relative to men at senior academic ranks and in scholarly productivity.