Maxwell Murphy Scher

All Publications

• National trends in laryngeal biopsy: Comparison of operative vs. office-based procedures AMERICAN JOURNAL OF OTOLARYNGOLOGY Scher, M., Bodnar, A., Tracy, J. C., Tracy, L. 2025; 46 (5): 104673

  Abstract

  To analyze national trends and prevalence of office-based endoscopy with laryngeal biopsy procedures as compared to traditional operative biopsy procedures utilizing direct laryngoscopy with and without microlaryngoscopy.The US Medicare Part B claims database was queried for Current Procedural Terminology (CPT) codes 31,576 (flexible laryngoscopy with biopsy), 31,535 (operative direct laryngoscopy with biopsy), and 31,536 (operative direct microlaryngoscopy with biopsy). From 2013 to 2022, the total number of charges billed to the Medicare database in each calendar year was recorded and annual trends were analyzed.The number of office-based flexible laryngoscopy biopsy procedures (CPT code 31576) remained relatively constant over the 10-year period of analysis (range: 551-852, trendline slope = -21, R2 = 0.51). Office-based flexible laryngoscopy biopsy procedures comprised a small portion of total laryngeal biopsies (range: 3.8 % - 4.8 %). The total number of operative direct laryngoscopy with biopsy, billed by CPT codes 31,535 and 31,536 experienced decline with time (Trendline slope = -310, R2 = 0.89; Trendline slope = -254, R2 = 0.85 respectively).Office-based laryngeal biopsy procedures comprise a small fraction of laryngeal biopsy procedures overall and prevalence has declined slightly over the last 10 years. This contrasts with prevailing healthcare trends towards less-invasive, office-based procedures. Further research is needed to determine the etiology of the overall decrease in operative direct laryngeal biopsies.

  View details for DOI 10.1016/j.amjoto.2025.104673

  View details for Web of Science ID 001499363800002

  View details for PubMedID 40412296

• National Trends in Laryngeal Laser Surgery: Comparison of Operative Versus Office-Based Procedures LARYNGOSCOPE Scher, M., Shave, S. M., Tracy, J. C., Tracy, L. F. 2025; 135 (2): 823-828

  Abstract

  To analyze national trends in the prevalence of office-based laryngeal ablative procedures and compare those with traditional operative excisional procedures utilizing direct laryngoscopy.For years 2013-2022, the US Medicare Part B claims database was searched for Current Procedural Terminology (CPT) codes 31572 (flexible laryngoscopy with laser ablation of lesion), 31540 (operative direct laryngoscopy with excision of lesion), 31541 (operative direct microlaryngoscopy with excision of lesion), and 31545 (operative direct microlaryngoscopy with excision of lesion and local tissue flap reconstruction). For each CPT code, the total number of charges billed to the Medicare database in each calendar year was recorded and annual trends were analyzed. Biopsy procedures were not included.The annual number of office-based laser procedures (CPT 31572) remained relatively constant since the CPT code was introduced in 2017 (range: 18887-25241 procedures annually, trendline slope = +16, R2:0.02). Office-based laser procedures comprised a small portion of total laryngeal excisional procedures (range: 8.4%-12.1%). The total number of operative laryngeal excisions, billed by CPT 31540 and 31541, declined over the studied time frame (Trendline slope = -132, R2:0.93; Trendline slope = -950, R2: 0.93 respectively).Office-based laser procedures comprise a small fraction of procedures to remove laryngeal lesions. The number of office-based laser procedures has been relatively stable over the last 5 years. This finding contrasts with the prevailing health care trend toward office-based procedures. Further research is needed to understand the decrease in operative laryngeal lesion excision procedures observed over the last 10 years.4 Laryngoscope, 135:823-828, 2025.

  View details for DOI 10.1002/lary.31847

  View details for Web of Science ID 001334834700001

  View details for PubMedID 39422366

• Full-thickness versus split-thickness skin graft reconstruction of scalp defects with and without calvarium exposure JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY Zhao, C. X., Scher, M., Hanks, J. E., McLean, S. A. 2024; 97: 275-281

  Abstract

  Compare full-thickness skin grafts versus split-thickness skin grafts in scalp reconstruction.Retrospective chart review of patients who underwent scalp reconstruction with skin grafts performed at a single institution from 2011 to 2016.χ2 or Fisher exact tests were used to compare graft integration and complication rates. The effects of graft type, defect type, graft size, and patient comorbidities on the likelihood of graft success and complications were analyzed using multivariate logistic regression.A hundred and twenty-five full-thickness and 93 split-thickness grafts were performed in 200 patients, including 68 defects (31.2%) with exposed calvarium. Full-thickness grafts required fewer average reconstructions (P = 0.002). A 92.8% of full-thickness grafts had complete graft integration compared with 78.5% of split-thickness grafts (P = 0.002). This difference was more evident in defects with exposed calvarium (87.2% vs. 47.6%, P ≤ 0.001). Despite higher rates of minor debridement, full-thickness grafts had less postoperative bone exposure and wound breakdown than split-thickness grafts on intact pericranium and exposed calvarium defects. Preoperative radiation, immunosuppression, and increased graft sizes were significant predictors of graft outcomes.Skin grafts, especially full-thickness, provide a versatile, reliable, and simple approach for reconstructing medium to large scalp defects in the appropriate patient. Even on defects with bare calvarium, full-thickness grafts can succeed when a vascularized recipient bed is prepared. Defects with exposed bone, larger graft sizes, preoperative radiation, and immunosuppression may result in decreased graft take and increased complications.3b.

  View details for DOI 10.1016/j.bjps.2023.10.053

  View details for Web of Science ID 001301248000001

  View details for PubMedID 39178692

• Outpatient Parotidectomy, a Safety and Financial Review ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Scher, M., Cabrera, C. I., Cai, Y., Tamaki, A., Li, S., Fowler, N., Rezaee, R., Lavertu, P., Teknos, T., Thuener, J. 2022; 131 (2): 205-210

  Abstract

  The objective of this study is to investigate the safety, efficacy, and potential cost-savings of the outpatient parotidectomy procedure.This is a retrospective chart review of all patients who underwent a parotidectomy at a large academic center from 2015 through 2019 including demographic data, postoperative complications, drain placement, readmission, and financial cost. A comparison was performed between patients who underwent an outpatient vs inpatient parotidectomy.A total of 335 patients underwent parotidectomy (136 outpatient; 199 inpatient). Comparison of patient demographics, common comorbidities, tumor size, tumor type, postoperative complications, and readmission rate was similar between the inpatient and outpatient cohorts. The overall mean cost difference between inpatient parotidectomy and outpatient parotidectomy for all years was $1528.58 (95%CI: $1139-$1916).The outpatient parotidectomy procedure has a comparable safety profile to the inpatient procedure while providing a significant cost-savings benefit.

  View details for DOI 10.1177/00034894211016714

  View details for Web of Science ID 000679743400001

  View details for PubMedID 33980056

• Impact of perioperative pain management protocol on opioid prescribing patterns Thuener, J. E., Clancy, K., Scher, M., Ascha, M., Harrill, K., Ahadizadeh, E., Rezaee, R., Fowler, N., Lavertu, P., Teknos, T., Zender, C. WILEY. 2020: 1180-1185

  Abstract

  The objective of this study was to demonstrate the impact of preoperative education, patient risk stratification, and a postoperative pain management protocol for common head and neck procedures on opioid prescribing patterns and postoperative pain reporting.Retrospective cohort study.A postoperative pain management protocol was developed and implemented for patients undergoing head and neck surgical procedures. Medical charts were queried and postoperative patient satisfaction surveys were administered. Opioid prescribing patterns were evaluated in cohorts of patients undergoing procedures with anticipated mild pain (e.g., thyroidectomy, parotidectomy, lymph node biopsy) before and after the implementation of the protocol. Postoperative patient surveys were analyzed in the postimplementation group.A total of 302 patients were included for analysis. One hundred fifty-four patients and 148 patients underwent surgery before and after the implementation of the protocol, respectively. There was a decreased incidence of oxycodone-containing prescriptions (83% to 26%), and tramadol became the most common discharge medication (70%). There was a significant decrease in the total number of pills prescribed after the implementation of the protocol (34.71 to 25.36, P < .001). Ninety percent of patients reported high satisfaction (≥8) with pain management.This study shows that a comprehensive pain management protocol can significantly reduce the amount and potency of opioid pain medication prescribed after head and neck procedures while maintaining high patient satisfaction.4 Laryngoscope, 130:1180-1185, 2020.

  View details for DOI 10.1002/lary.28133

  View details for Web of Science ID 000528051200034

  View details for PubMedID 31188488