Risk factors for inpatient hospital admission following isolated orbital floor fractures.

Orbital floor fractures are common injuries seen in the emergency department (ED). In this study, the National Trauma Data Bank (NTDB, 2016-2017) was used to identify patients presenting with isolated orbital floor trauma. Patient-specific factors were analyzed to determine associations with management. The sample comprised 912 patients; 285 (31.3%) of these patients were discharged from the ED, 541 (59.3%) were admitted to the hospital but did not undergo an operation, and 86 (9.4%) underwent operative treatment. Pediatric patients and older patients (<18 years and>55 years) were more likely to be admitted than those aged 18-55 years, and pediatric patients were more likely to undergo an urgent operative intervention than those in the other age groups (all P < 0.001). Patients with alcohol use disorder (P = 0.002) and hypertension (P = 0.004) had increased odds of admission. Private and Medicare insurance patients were more likely to be admitted, and self-pay patients less likely (P < 0.001). Older age and Medicaid payor status showed increased odds of a greater hospital length of stay. Biological sex, race/ethnicity, functionally dependent health status, myocardial infarction, steroid use, and substance use disorder were not associated with discharge disposition. There are non-injury related, patient-specific factors that may influence the management of orbital floor fractures.

The importance of adjuvant treatment and primary anatomical site in head and neck basaloid squamous cell carcinoma survival: an analysis of the National Cancer Database.

PURPOSE: Basaloid squamous cell carcinoma (BSCC) of the head and neck is an aggressive and highly malignant variant of squamous cell carcinoma that accounts for 2% of head and neck cancers. Previous studies have not analyzed the significance of adjuvant chemoradiation and anatomical site within BSCC subtype and its impact on survival. METHODS: A cohort of 1999 patients with BSCC of the head and neck was formed from the National Cancer Database and analyzed with descriptive studies, median survival and 5- and 10-year survival. A multivariable Cox hazard regression was performed to determine the prognostic significance of anatomical site and adjuvant therapy. RESULTS: The most common primary anatomical site was the oropharynx (71.9%) followed by oral cavity (11.5%), larynx (10.1%), hypopharynx (3.5%), esophagus (1.9%), and nasopharynx (1.1%). The presence of metastasis increased the risk of mortality (HR = 2.14; 95% CI 1.40-3.26). Tumors localized to the oropharynx demonstrated better survival compared to all sites except nasopharynx, including the oral cavity (HR = 2.45; 95% CI 1.83-3.29), hypopharynx (HR = 2.58; 95% CI:1.64-4.05), and larynx (HR = 2.89; 95% CI:2.25-3.73). Adjuvant chemoradiation (HR = 0.36; 95% CI 0.23-0.58) and adjuvant radiation (HR = 0.38; 95% CI 0.23-0.64) had better survival outcomes compared to adjuvant chemotherapy. Patients with microscopic margins had better survival outcomes when compared to no surgery (HR = 0.38, 98% Cl 0.23-0.64) while there were no better survival outcomes of patients with macroscopic margins compared to no surgery. CONCLUSION: This study illustrated that tumors in the oropharynx, lower age, adjuvant chemoradiation and radiation, and microscopic margins were associated with greater survival.

Important prognostic factors in leiomyosarcoma survival: a National Cancer Database (NCDB) analysis.

BACKGROUND: Leiomyosarcoma (LMS) is an aggressive, malignant mesenchymal tumor with characteristic smooth muscle lineage accounting for 10-20% of all soft tissue tumors. The goal of this study is to determine the impact of prognostic factors on leiomyosarcoma survival irrespective of primary anatomical site. METHODS: There were a total of 7154 patients with primary leiomyosarcoma identified and analyzed from the National Cancer Database. Descriptive statistics, median survival, and 5- and 10-year survival probabilities were calculated along with a Cox proportional hazard model to determine independent prognostic factors. RESULTS: In this study, females comprised 68.3% of the cohort with a median age of 58 years. The most common primary anatomical sites were the extremities followed by female reproductive organs, abdomen, pelvis, thorax or lung, and head or neck. Tumors localized in the female reproductive organs had the worst survival (5-year survival probability: 45.3%), while tumors localized in the extremities had the best survival outcomes (5-year survival probability: 73.4%). Surgery with adjuvant radiation yielded better outcomes compared to surgery alone (HR 0.82, 95% CI 0.74-0.91). Microscopic and macroscopic margins resulted in a 32% and a 134% increased risk in mortality, respectively, when compared to negative surgical margins (p < 0.0001). CONCLUSION: This study showed a significantly higher risk of mortality associated with older patients, tumors localized to the female reproductive organs, African American patients, higher tumor stage, increased Charlson/Deyo scores, tumors treated with surgery alone without adjuvant radiation, and tumors with positive microscopic, macroscopic, or indeterminate surgical margins.