Zheng, Melissa

Abstract Objective Determine relationship between frailty and hospital mortality, length of stay, cost, and medical and surgical complications in Zenker diverticulum surgery. Study Design Retrospective cross‐sectional. Setting National database. Methods Data from the National Inpatient Sample for 712 patients who underwent surgery for Zenker diverticulum 2016 to 2021 were analyzed using multivariate regressions. Frailty was defined as at least 1 frailty‐defining diagnosis from the Johns Hopkins ACG® Frailty Indicator. Elixhauser Comorbidity Index was calculated to quantify comorbidity burden. Results 12.2% of patients were identified as frail, 77.0% of whom had a weight loss or malnutrition diagnosis. Frailty predicted increased length of stay (mean, 4.09 days [95% CI: 2.98‐5.20]) and increased costs (mean, $10,500.36 [95% CI: $6885.76‐$14,114.95]). Frail patients were more likely to have medical complications compared to non‐frail patients (OR = 2.84 [95% CI: 1.66‐4.84]). Elixhauser Comorbidity Index was predictive of hospital mortality (OR = 1.78 [95% CI: 1.27‐2.51]) and likelihood of endoscopic surgical complications (OR = 1.25 [95% CI: 1.05‐1.47]), but frailty was not predictive of either. Conclusion Frailty is not associated with increased risk of surgical complications or mortality and is not an absolute contraindication to Zenker diverticulum surgery. Frailty predicts length of stay, costs, and medical complications in Zenker diverticulum surgery and should be used with comorbidity to stratify patient risk for surgery. Prospective studies involving frail patients could help develop a standardized method for assessing surgical fitness, potentially expanding treatment options and improving outcomes for this population. Level of Evidence 2.

Introduction This study queries the US laryngology workforce geographic distribution and density and models laryngology workforce trends through 2050. Methods A national database of fellowship‐trained laryngologists (FTLs) and nonfellowship‐trained laryngologists (nFTLs) practicing primarily laryngology was formed by identifying laryngologists via internet search, with validation by regional laryngologists and senior laryngologists on this manuscript. Demographic variables included residency and/or fellowship graduation year, institutional affiliation, and practice zip code. US Census Bureau population data and projections were grouped by hospital referral region (HRR), as defined by the Dartmouth Healthcare Atlas. The National Resident Matching Program (NRMP) provided annual fellowship match data from 2012 to 2022. Results As of May 2023, there were 349 active laryngologists in the United States, including 303 FTLs. The median practice length for all laryngologists was 11 years. HRRs with the largest number of laryngologists were Manhattan, Boston, and Los Angeles, with 23, 16, and 14 respectively. One hundred and ninety‐four of 306 (63%) HRRs did not have an active, primary laryngologist. The national median density of people per laryngologist including HRRs with at least one laryngologist was 645,160. Assuming a 35‐year practice horizon prior to workforce exit and holding the 2018–2022 NRMP average of 18 fellows constant, the number of forecasted laryngologists by 2040 would be 568—an increase of 66%. Conclusions To date, no comprehensive database of practicing US laryngologists nor laryngology workforce forecast exists. Based on current benchmarks, the laryngology workforce would increase by 66% by 2040, ideally addressing the current dearth of laryngologists in low‐density areas. Level of Evidence NA Laryngoscope , 135:1759–1766, 2025

ObjectivesTo analyze demographic trends in laryngology fellowship training in the United States from 1993 to 2022, comparing periods before and after formalization of the fellowship within the National Resident Matching Program (NRMP) in 2012.MethodsA national database of fellowship‐trained laryngologists (FTLs) and non‐fellowship‐trained laryngologists (nFTLs) practicing primarily laryngology was created by methodically compiling laryngologists via Internet search, with corroboration by regional laryngologists and vetting by senior laryngologists on this manuscript. Demographic variables included residency and/or fellowship graduation year, gender, race and ethnicity inferred through individuals' photos and surnames. NRMP match data from 2012 to 2022 were obtained from the American Laryngological Association.ResultsAn average of 21 programs offered 23 positions in the NRMP match, with 14 programs (66.4%) filling 16 positions (68.8%) from 2012 to 2022. The 10‐year FTL growth rate decreased from 25.4% (1993–2002) to 10.5% and 6.6% in subsequent periods. In May 2023, there were 349 active laryngologists, including 303 FTLs, in the United States. A total of 189 (62.4%) FTLs were men, 114 (37.6%) were women; 201 (66.2%) were White, 102 (33.8%) were non‐White. Between the pre‐NRMP and post‐NRMP periods, the percentage of male FTLs decreased from 71.5% to 55.5%, female FTLs increased from 28.5% to 44.5%, and White FTLs decreased from 69.2% to 64.2%. Chi‐squared analysis yielded a statistically significant association between gender and training period for FTLs (p = 0.004), but no statistically significant difference between race and training period.ConclusionsThe post‐NRMP period saw an expansion of laryngology fellowships and workforce diversification, reflecting trends observed in otolaryngology and medicine overall.Level of EvidenceNA Laryngoscope, 135:794–800, 2025