Three-Dimensional Printing for Craniofacial Surgery: A Single Institution's 5-Year Experience.

BACKGROUND: As 3-dimensional (3D) printers and models become more widely available and increasingly affordable, surgeons may consider investing in a printer for their own cleft or craniofacial center. To inform surgeons considering adoption of this evolving technology, this study describes one multi-surgeon center's 5-year experience using a 3D printer. METHODS: This study included 3D models printed between October 2012 and October 2017. A 3D Systems ZPrinter 650 was used to create all models. Models were subclassified by type (craniofacial vs noncraniofacial) and diagnosis, and the cost of consumable materials was recorded. A survey was distributed to craniofacial team members who used the printed models. Likert scales and free texts were used for responses about lessons learned and the usefulness of the printer for different craniofacial indications. RESULTS: A total of 106 models were printed at this institution during the 5-year time period. Printing times were 7.4 ± 1.9 hours for complete skulls and 6.0 ± 1.7 hours for maxillofacial prints. The average cost for a complete skull was about US$60 in material cost alone. The 3D printer was most frequently used for complex craniosynostosis, hemifacial microsomia syndrome, and fibrous dysplasia cases. The surgeons found the printer to be most useful for planning complex facial orthognathic cases and least useful for routine single-suture synostosis. CONCLUSION: Three-dimensional printing was found to be helpful for all 4 craniofacial surgeons, who would all invest again in a 3D printer. For lower volume centers, commercially printed models may be a more cost-effective alternative.

Hospital burden of unintentional carbon monoxide poisoning in the United States, 2007.

BACKGROUND: Unintentional, non-fire-related (UNFR) carbon monoxide (CO) poisoning is a leading cause of poisoning in the United States, but the overall hospital burden is unknown. This study presents patient characteristics and the most recent comprehensive national estimates of UNFR CO-related emergency department (ED) visits and hospitalizations. METHODS: Data from the 2007 Nationwide Inpatient and Emergency Department Sample of the Hospitalization Cost and Utilization Project were analyzed. The Council of State and Territorial Epidemiologists' CO poisoning case definition was used to classify confirmed, probable, and suspected cases. RESULTS: In 2007, more than 230,000 ED visits (772 visits/million) and more than 22,000 hospitalizations (75 stays/million) were related to UNFR CO poisoning. Of these, 21,304 ED visits (71 visits/million) and 2302 hospitalizations (8 stays/million) were confirmed cases of UNFR CO poisoning. Among the confirmed cases, the highest ED visit rates were among persons aged 0 to 17 years (76 visits/million) and 18 to 44 years (87 visits/million); the highest hospitalization rate was among persons aged 85 years or older (18 stays/million). Women visited EDs more frequently than men, but men were more likely to be hospitalized. Patients residing in a nonmetropolitan area and in the northeast and midwest regions of the country had higher ED visit and hospitalization rates. Carbon monoxide exposures occurred mostly (>60%) at home. The hospitalization cost for confirmed CO poisonings was more than $26 million. CONCLUSION: Unintentional, non-fire-related CO poisonings pose significant economic and health burden; continuous monitoring and surveillance of CO poisoning are needed to guide prevention efforts. Public health programs should emphasize CO alarm use at home as the main prevention strategy.

The role of income in reducing racial and ethnic disparities in emergency room and urgent care center visits for asthma-United States, 2001-2009.

OBJECTIVE: To examine racial/ethnic disparities and associated factors in asthma-related emergency room (ER) and urgent care center (UCC) visits among US adults and determine whether disparities vary across increasing income strata. METHODS: We analyzed data from 238,678 adult respondents from the 2001 to 2009 National Health Interview Survey and calculated the weighted annual prevalence of an ER/UCC visit for persons with current asthma. We used logistic regression to calculate adjusted odds ratios (AORs) for asthma-related ER/UCC visits by race/ethnicity and income, adjusting for demographics, socioeconomic, and other health-related factors. RESULTS: The average annual prevalence of asthma-related ER/UCC visits among adults with current asthma was highest for Puerto Ricans (24.8%, 95% confidence interval [CI]: 20.3-29.9) followed by non-Hispanic American Indian/Alaskan Natives (22.1%, 95% CI: 14.4-32.4), non-Hispanic blacks (20.4%, 95% CI: 18.5-22.4), other Hispanics (17.3%, 95% CI: 15.0-19.9), Asians (11.0%, 95% CI: 7.8-15.4), and non-Hispanic whites (10.1%, 95% CI: 9.4-10.9). Puerto Ricans (AOR: 2.01; 95% CI: 1.54-2.62), non-Hispanic blacks (AOR: 1.72; 95% CI: 1.46-2.03), and other Hispanics (AOR: 1.55; 95% CI: 1.25-1.92) with current asthma had significantly higher odds of an asthma-related ER/UCC visit than non-Hispanic whites. Lower socioeconomic status, obesity, and serious psychological distress were also associated with higher odds of asthma-related ER/UCC visits. Puerto Ricans with the lowest income (AOR: 3.52; 95% CI: 2.27-5.47), non-Hispanic American Indian/Alaskan Natives with the highest income (AOR: 5.71; 95% CI: 1.48-22.13), and non-Hispanic blacks in every income stratum had significantly higher odds of asthma-related ER/UCC visits compared to non-Hispanic whites in the highest income stratum. CONCLUSIONS: Racial/ethnic disparities in asthma-related ER/UCC visits persist after accounting for income and other socioeconomic factors. Further research is needed to identify modifiable risk factors directly associated to race/ethnicity to decrease the asthma burden on minority populations.

Hospital Burden of Migraine in United States Adults: A 15-year National Inpatient Sample Analysis.

BACKGROUND: Migraine headache is associated with high costs, but changes over time of inpatient burden in the United States are unknown. Understanding longitudinal trends is necessary to determine the costs of evolving inpatient treatments that target biological factors in the generation of pain such as vasodilation and aberrant activity of trigeminal neurotransmitters. We report the migraine hospital burden trend in the United States over 15 years. METHODS: Data from the Nationwide Inpatient Sample of the Hospitalization Cost and Utilization Project databases were analyzed from 1997 to 2012. Inpatient costs were reported in dollars for the cost to the institution, whereas charges reflect the amount billed. These parameters were trended and the average annual percent change was calculated to illustrate year-to-year changes. RESULTS: Overall discharges for migraine headache reached a low of 30,761 discharges in 1999, and peaked in 2012 with 54,510 discharges. Average length of stay decreased from 3.5 days in 1997 to 2.8 days in 2012. Total inpatient charges increased from $176 million in 1999 to $1.2 billion in 2012. Inpatient costs totaled $322 million in 2012, with an average daily cost of $2,111. CONCLUSIONS: Inpatient burden rapidly increased over the analyzed period, with hospital charges increasing from $5,939 per admission and $176 million nationwide in 1997, to $21,576 per admission and $1.2 billion nationwide in 2012. This trend provides context for research examining cost-effectiveness and quality of life benefits for current treatments. The study of these parameters together with better prevention and improved outpatient treatment may help alleviate the inpatient burden of migraine.

An Association between Carpal Tunnel Syndrome and Migraine Headaches-National Health Interview Survey, 2010.

BACKGROUND: Migraine headaches have not historically been considered a compression neuropathy. Recent studies suggest that some migraines are successfully treated by targeted peripheral nerve decompression. Other compression neuropathies have previously been associated with one another. The goal of this study is to evaluate whether an association exists between migraines and carpal tunnel syndrome (CTS), the most common compression neuropathy. METHODS: Data from 25,880 respondents of the cross-sectional 2010 National Health Interview Survey were used to calculate nationally representative prevalence estimates and 95% confidence intervals (95% CIs) of CTS and migraine headaches. Logistic regression was used to calculate adjusted odds ratios (aORs) and 95% CI for the degree of association between migraines and CTS after controlling for known demographic and health-related factors. RESULTS: CTS was associated with older age, female gender, obesity, diabetes, and smoking. CTS was less common in Hispanics and Asians. Migraine was associated with younger age, female gender, obesity, diabetes, and current smoking. Migraine was less common in Asians. Migraine prevalence was 34% in those with CTS compared with 16% in those without CTS (aOR, 2.60; 95% CI, 2.16-3.13). CTS prevalence in patients with migraine headache was 8% compared with 3% in those without migraine headache (aOR, 2.67; 95% CI, 2.22-3.22). CONCLUSIONS: This study is the first to demonstrate an association between CTS and migraine headache. Longitudinal and genetic studies with physician verification of migraine headaches and CTS are needed to further define this association.