Featured Publications
Identifying Opportunities to Deliver High‐Quality Cancer Care Across a Health System: A Clinical Responsibility
Shah H, Cohen O, Bourdillon A, Burtness B, Boffa D, Young M, Judson B, Mehra S. Identifying Opportunities to Deliver High‐Quality Cancer Care Across a Health System: A Clinical Responsibility. Otolaryngology 2024, 171: 445-456. PMID: 38606669, DOI: 10.1002/ohn.755.Peer-Reviewed Original ResearchOral squamous cell carcinomaHealth systemCancer careLymph node yieldDeliver high-quality cancer careHigh-quality cancer careBaseline quality of careReporting of Observational StudiesFragmentation of careQuality of careFacility typeCommunity facilitiesOdds of positive surgical marginsAssociated with increased oddsPositive surgical margin rateCombination groupAcademic centersPositive surgical marginsTreating facility typeSurgical margin ratePrimary outcome measureSquamous cell carcinomaGuideline-adherent treatmentCombined careEpidemiology guidelinesGuideline - Adherence in advanced stage head and neck cancer is associated with improved survival – A National study
Cohen O, Brauer PR, Judson BL, Burtness BA, Earles J, Mehra S. Guideline - Adherence in advanced stage head and neck cancer is associated with improved survival – A National study. Oral Oncology 2021, 125: 105694. PMID: 34971883, DOI: 10.1016/j.oraloncology.2021.105694.Peer-Reviewed Original ResearchConceptsOverall survivalNCCN guidelinesGuideline adherenceAdherence ratesNeck cancerAdvanced stage HNCGuideline adherence rateOverall stage IIINational Cancer DatabaseDecreased overall survivalAdvanced-stage headPrevalence of guidelinesComorbidity scoreAdherent patientsAdvanced headClinical stagingImproved survivalGuideline awarenessHNC patientsBlack raceInsurance statusNational cohortCancer DatabaseRisk factorsFemale genderChanges in Population-Level and Institutional-Level Prescribing Habits of Radioiodine Therapy for Papillary Thyroid Cancer
Jacobs D, Breen CT, Pucar D, Holt E, Judson BL, Mehra S. Changes in Population-Level and Institutional-Level Prescribing Habits of Radioiodine Therapy for Papillary Thyroid Cancer. Thyroid 2020, 31: 272-279. PMID: 32811347, DOI: 10.1089/thy.2020.0237.Peer-Reviewed Original ResearchConceptsPapillary thyroid cancerNational Cancer DatabaseThyroid cancerRadioactive iodine therapyNumber of patientsHospital-specific effectsIodine therapyAdvanced diseaseTotal thyroidectomyRadioiodine therapyPrescribing habitsRAI useCancer DatabaseMixed regression modelsPatientsJoinpoint analysisHospitalIndividual hospitalsCancerHospital selectionNational trendsThyroidectomyTherapySignificant declineRegression modelsPositive margin rates and predictors in transoral robotic surgery after federal approval: A national quality study
Hanna J, Morse E, Brauer PR, Judson B, Mehra S. Positive margin rates and predictors in transoral robotic surgery after federal approval: A national quality study. Head & Neck 2019, 41: 3064-3072. PMID: 31058417, DOI: 10.1002/hed.25792.Peer-Reviewed Original ResearchConceptsPositive margin rateTransoral robotic surgeryLow positive margin rateLow-volume facilitiesHigh-volume facilitiesPositive marginsT classificationMargin rateHuman papilloma virus (HPV) statusRobotic surgeryLymph-vascular invasionNational Cancer DatabaseMargin statusRetrospective reviewTumor subsiteVirus statusCancer DatabaseMultivariable regressionLinear associationPatientsSurgeryQuality studiesStatusAssociationClinical value of transoral robotic surgery: Nationwide results from the first 5 years of adoption
Li H, Torabi SJ, Park HS, Yarbrough WG, Mehra S, Choi R, Judson BL. Clinical value of transoral robotic surgery: Nationwide results from the first 5 years of adoption. The Laryngoscope 2018, 129: 1844-1855. PMID: 30575965, DOI: 10.1002/lary.27740.Peer-Reviewed Original ResearchMeSH KeywordsCarcinoma, Squamous CellChemoradiotherapy, AdjuvantChi-Square DistributionCombined Modality TherapyDatabases, FactualFemaleHumansKaplan-Meier EstimateMaleMargins of ExcisionMiddle AgedMultivariate AnalysisNatural Orifice Endoscopic SurgeryNeoplasm StagingOropharyngeal NeoplasmsProportional Hazards ModelsRegression AnalysisRetrospective StudiesRobotic Surgical ProceduresTreatment OutcomeUnited StatesConceptsOropharyngeal squamous cell carcinomaTransoral robotic surgeryTransoral laser microsurgeryNonrobotic surgeryTORS patientsPositive marginsTLM patientsLower likelihoodT2 oropharyngeal squamous cell carcinomaEarly stage oropharyngeal squamous cell carcinomaLong-term oncologic outcomesUse of TORSKaplan-Meier log-rank testRobotic surgeryNational Cancer DatabaseMajority of patientsMultivariate Cox analysisSquamous cell carcinomaLog-rank testChi-square testCox multivariateN3 diseaseAdjuvant chemoradiotherapyAdjuvant radiotherapyAdjuvant therapyA Clinical Care Pathway to Reduce ICU Usage in Head and Neck Microvascular Reconstruction
Morse E, Henderson C, Carafeno T, Dibble J, Longley P, Chan E, Judson B, Yarbrough WG, Sasaki C, Mehra S. A Clinical Care Pathway to Reduce ICU Usage in Head and Neck Microvascular Reconstruction. Otolaryngology 2018, 160: 783-790. PMID: 30060705, DOI: 10.1177/0194599818782404.Peer-Reviewed Original ResearchConceptsClinical care pathwayLength of stayReadmission ratesFree flap patientsCare pathwayICU admissionSurgical complicationsFlap patientsIntensive care unit admissionNeck free flap patientsRoutine ICU admissionCare unit admissionNumber of patientsNeck microvascular reconstructionFree tissue transferReconstruction of headPrepathway groupUnit admissionPostoperative complicationsPostoperative lengthVentilatory supportMedical complicationsMedian lengthPatient populationPathway implementationTreatment Delays in Primarily Resected Oropharyngeal Squamous Cell Carcinoma: National Benchmarks and Survival Associations
Morse E, Judson B, Husain Z, Burtness B, Yarbrough WG, Sasaki C, Cheraghlou S, Mehra S. Treatment Delays in Primarily Resected Oropharyngeal Squamous Cell Carcinoma: National Benchmarks and Survival Associations. Otolaryngology 2018, 159: 987-997. PMID: 30060700, DOI: 10.1177/0194599818779052.Peer-Reviewed Original ResearchHPV-positive patientsRadiation treatment durationTotal treatment packageOverall survivalTreatment initiationTreatment durationEnd intervalOropharyngeal cancerTreatment delayTreatment packageOropharyngeal squamous cell carcinomaCox proportional hazards regressionMultivariable logistic regression analysisRadiation treatmentRetrospective cross-sectional analysisNational Cancer DatabaseProportional hazards regressionSquamous cell carcinomaDuration of diagnosisLogistic regression analysisNational benchmarksCross-sectional analysisMedian durationOverall cohortHazards regression
2024
A Rare Pediatric Mandibular Mass: Diagnosis, Treatment and Reconstruction: A Case Report
Susan S, Gorman L, Santore E, Boldikova D, Ibrahim G, Kravchenko D, Khan M, Johnson D, Mehra S, Laskin W, Eskendri J. A Rare Pediatric Mandibular Mass: Diagnosis, Treatment and Reconstruction: A Case Report. Oral Surgery Oral Medicine Oral Pathology And Oral Radiology 2024, 138: e63. DOI: 10.1016/j.oooo.2024.04.096.Peer-Reviewed Original ResearchSclerosing epithelioid fibrosarcomaFibular free flap reconstructionHigh risk of metastasisAggressive clinical courseMetastasis 9 monthsRisk of metastasisEpisodes of recurrenceFree flap reconstructionMalignant fibroblastic neoplasmExcisional surgeryClinical courseFlap reconstructionHyalinized stromaAdjunctive therapyPoor prognosisSurgical siteEpithelioid cellsTreatment planningMiddle aged adultsTreatment protocolsFibroblastic neoplasmRight mandibleHigh riskMUC4 immunoreactivityLower extremitiesPredisposing, Enabling, and Need Factors Driving Palliative Care Use in Head and Neck Cancer.
Fereydooni S, Valdez C, William L, Malik D, Mehra S, Judson B. Predisposing, Enabling, and Need Factors Driving Palliative Care Use in Head and Neck Cancer. Otolaryngology 2024 PMID: 38796734, DOI: 10.1002/ohn.819.Peer-Reviewed Original ResearchPalliative careAssociated with palliative carePC usePalliative care useAnderson Behavioral ModelHealth service useHigher incomePrivate insuranceHead and neck cancerNational Cancer DatabaseHigher comorbidity indexMultivariate logistic regressionCare useService useMonths of lifeNeed factorsInformational counselingEnabling factorsHispanic ethnicityPC indicatorsCancer DatabaseNeck cancerBlack raceRetrospective studyCurative treatmentRe: “Prophylactic Intraoperative Antibiotic Dosing in Head and Neck Surgery: Opportunities for Improvement and Future Study”
Mehra S. Re: “Prophylactic Intraoperative Antibiotic Dosing in Head and Neck Surgery: Opportunities for Improvement and Future Study”. Otolaryngology 2024, 171: 310-310. PMID: 38606625, DOI: 10.1002/ohn.768.Peer-Reviewed Original ResearchPatterns of Care for T1 Glottic Squamous Cell Carcinomas from 2004–2020
Malik D, Jacobs D, Fereydooni S, Park H, Mehra S. Patterns of Care for T1 Glottic Squamous Cell Carcinomas from 2004–2020. The Laryngoscope 2024, 134: 3633-3644. PMID: 38411338, DOI: 10.1002/lary.31363.Peer-Reviewed Original ResearchGlottic squamous cell carcinomaT1 glottic squamous cell carcinomaSquamous cell carcinomaDual-modality treatmentOver-treatmentT1a tumorsCell carcinomaTreatment regimensOverall treatment modalityNational Cancer DatabaseRate of surgeryYear of treatmentMultivariate logistic regressionCochran-Armitage testT1b tumorsT1b diseaseCancer DatabaseOver-treatedTreatment modalitiesTreatment patternsAssociated with greater likelihoodSurgeryPatientsTumorLogistic regressionEnvironmental Impact of a Direct Laryngoscopy: Opportunities for Pollution Mitigation
Filley G, Kayastha D, Hayes W, Mehra S, Sherman J, Eckelman M. Environmental Impact of a Direct Laryngoscopy: Opportunities for Pollution Mitigation. The Laryngoscope 2024, 134: 3206-3214. PMID: 38379176, DOI: 10.1002/lary.31341.Peer-Reviewed Original ResearchGlobal warming potentialLife cycle assessmentEnvironmental impact categoriesImpact categoriesEnvironmental impactWater consumptionAlternative scenariosCycle assessmentPollution mitigationWarming potentialHuman healthDecontamination standardsNon-sterileYale-New Haven HospitalEnvironmental benefitsDecontaminationTertiary medical centerWaterSteam sterilizationCenters for Disease Control (CDCPollutionHigh-level disinfectionSurgical proceduresDirect laryngoscopySurgical towelsThe Impact of Four Smoking Metrics on Survival After Diagnosis with HPV+ Oropharyngeal Cancer
Wilkins S, Shah R, Safranek C, Shah H, Mehra S. The Impact of Four Smoking Metrics on Survival After Diagnosis with HPV+ Oropharyngeal Cancer. The Laryngoscope 2024, 134: 3158-3164. PMID: 38294283, DOI: 10.1002/lary.31319.Peer-Reviewed Original ResearchOropharyngeal squamous cell carcinomaRecurrence-free survivalHPV+ oropharyngeal squamous cell carcinomaOverall survivalPack-yearsTobacco useRetrospective review of patientsImpact overall survivalReview of patientsSquamous cell carcinomaSmoking metricsInferior OSImpact of tobacco useMetastatic diseaseImpact of smokingPrognostic significanceRetrospective reviewCell carcinomaSmoking historyUnivariate analysisNever-smokersMultivariate analysisSmoking statusPatientsInclusion criteria
2023
Automated AJCC Restaging for Oropharyngeal Cancer Research
Safranek C, Wilkins S, Shah R, Mehra S. Automated AJCC Restaging for Oropharyngeal Cancer Research. Otolaryngology 2023, 170: 627-629. PMID: 37855637, DOI: 10.1002/ohn.558.Peer-Reviewed Original ResearchOropharyngeal squamous cell carcinomaComputational toolsData setsLarge data setsOpen-source designSimilar toolsHuman papillomavirus-positive oropharyngeal squamous cell carcinomaAmerican Joint CommitteeHPV-negative counterpartsSquamous cell carcinomaGuideline updateCell carcinomaAJCC editionToolEdition criteriaClinical tumorsJoint CommitteeSetCancer typesAlgorithmAccurate analysisAJCCCancer researchRole of PET/CT in Oropharyngeal Cancers
Avery E, Joshi K, Mehra S, Mahajan A. Role of PET/CT in Oropharyngeal Cancers. Cancers 2023, 15: 2651. PMID: 37174116, PMCID: PMC10177278, DOI: 10.3390/cancers15092651.Peer-Reviewed Original ResearchTrends in Private Equity Acquisitions of US Otolaryngology Practices
Shah H, Salehi P, Torabi S, Bourdillon A, Wu K, Mehra S. Trends in Private Equity Acquisitions of US Otolaryngology Practices. Otolaryngology 2023, 169: 1094-1097. PMID: 37003295, DOI: 10.1002/ohn.342.Peer-Reviewed Original Research
2022
Human Immunodeficiency Virus Is Associated With Poor Overall Survival Among Patients With Head and Neck Cancer
Salahuddin S, Cohen O, Wu M, Irizarry J, Vega T, Gan G, Deng Y, Isaeva N, Prasad M, Schalper K, Mehra S, Yarbrough W, Emu B. Human Immunodeficiency Virus Is Associated With Poor Overall Survival Among Patients With Head and Neck Cancer. Clinical Infectious Diseases 2022, 76: 1449-1458. PMID: 36520995, PMCID: PMC10319962, DOI: 10.1093/cid/ciac924.Peer-Reviewed Original ResearchConceptsOverall survivalIndependent predictorsHNSCC patientsWorse prognosisOropharyngeal tumorsCox proportional hazards regression modelMultivariate analysisHPV-positive oropharyngeal tumorsNeck squamous cell cancerProportional hazards regression modelsLower median overall survivalAcademic hospital centerNon-HIV populationMedian overall survivalPredictors of survivalSquamous cell cancerHuman immunodeficiency virusPoor clinical outcomeExpression of CD4Poor overall survivalHazards regression modelsRace/ethnicityCD8 infiltrationHazard ratioClinicopathologic characteristicsMucosal haemangioma in the setting of treatment with trastuzumab emtansine (T‐DM1)
Belzer A, Silber A, Mehra S, Gilani S, Leventhal JS. Mucosal haemangioma in the setting of treatment with trastuzumab emtansine (T‐DM1). British Journal Of Dermatology 2022, 187: e168-e168. PMID: 35633104, DOI: 10.1111/bjd.21654.Peer-Reviewed Case Reports and Technical NotesProphylactic Intraoperative Antibiotic Dosing in Head and Neck Surgery: Opportunities for Improvement and Future Study
Shah R, Cohen O, Panth N, Dibble J, Paolillo D, Cook A, Mehra S. Prophylactic Intraoperative Antibiotic Dosing in Head and Neck Surgery: Opportunities for Improvement and Future Study. Otolaryngology 2022, 169: 482-488. PMID: 36113029, DOI: 10.1177/01945998221126144.Peer-Reviewed Original ResearchConceptsIntraoperative antibiotic prophylaxisFree tissue transferAntibiotic prophylaxisAmpicillin-sulbactamNeck surgeryTissue transferAdherence ratesGuideline adherence rateProphylactic antibiotic regimenNeck oncologic surgeryRetrospective case seriesSingle academic centerSecondary exploratory analysisFrequency of administrationAntibiotic typeAntibiotic regimenGuideline adherencePostoperative infectionAntibiotic dosingCase seriesDosing recommendationsFuture studiesOncologic surgeryDose 2Dose 3Impact of HIV infection on clinical outcomes among people diagnosed with head and neck cancer.
Salahuddin S, Cohen O, Wu M, Irizarry J, Vega T, Gan G, Deng Y, Isaeva N, Schalper K, Mehra S, Yarbrough W, Emu B. Impact of HIV infection on clinical outcomes among people diagnosed with head and neck cancer. Journal Of Clinical Oncology 2022, 40: e18080-e18080. DOI: 10.1200/jco.2022.40.16_suppl.e18080.Peer-Reviewed Original ResearchOropharyngeal squamous cell carcinomaCD8 T cell infiltrationPD-L1 expressionUninfected patientsT cell infiltrationPoor outcomeHNC patientsInsurance statusRace/ethnicityMedian survivalQuantitative immunofluorescenceIndependent predictorsClinical outcomesViral loadCell infiltrationNeck cancerAnatomic sitesTobacco useMultivariate analysisLow PD-L1 expressionCombination antiretroviral therapy eraTumor microenvironmentAntiretroviral therapy eraMedian CD4 countHIV viral load