Effects of saline submersion at body temperature on airway supportive devices including a novel nasopharyngeal device produced using 3D-printing.

PURPOSE: This study investigated dimension changes of various nasopharyngeal airways, including a novel self-supporting device, after saline submersion at body temperature to simulate in-vivo use. Dimension changes over time may reduce efficacy during long-term use and require sizing adjustments or limits on duration of use. MATERIALS AND METHODS: Cuffless Covidien endotracheal tubes, pediatric Rusch fixed flange polyvinyl chloride nasal airway tubes, pediatric Rusch Robertazzi style Mediprene nasal airway tubes, and novel silicone elastomer self-supporting nasopharyngeal airways were fully submerged in 0.9 % normal saline solution incubated at 37 degrees Celsius for 15 days. All devices had tube length and wall thickness measured after 0, 1, 2, 3, 4, 5, 10, and 15 days. The 95 % confidence intervals of tube dimensions at each date were compared with the 95 % confidence intervals at day 0. RESULTS: The Covidien ET tube, Rusch PVC NPA, and ssNPA tube lengths and wall thicknesses did not change significantly over 15 days. The Rusch Mediprene NPAs had a statistically significant increase in length starting at day 1 and wall thickness at day 2. CONCLUSIONS: The novel ssNPA did not expand in the in-vitro environment, supporting its safety for extended use. The PVC NPA and ET tube dimensions also remained stable. However, the Rusch Mediprene NPAs had significant length expansion after 1 day of submersion, indicating a considerable risk of expansion during extended use with potential implications for patient care. Silicone and PVC NPA dimensions remained stable when saturated, indicating these materials may be more appropriate for extended use.

The Impact of Surgeon Adherence to Preoperative Optimization of Hernia Repairs.

BACKGROUND: At the patient level, optimizing risk factors before surgery is a proven approach to improve patient outcomes after hernia repair. However, nearly 25% of patients are not adequately optimized before surgery. It is currently unknown how surgeon-level adherence to preoperative optimization impacts postoperative outcomes. In this context, we evaluated the association between surgeon adherence to optimization practices and surgeon-level postoperative outcomes. MATERIALS AND METHODS: Michigan Surgical Quality Collaborative data from 2014 to 2018 was analyzed to examine rates of surgeon adherence to preoperative optimization when performing elective ventral and incisional hernia repair. Adherence was defined as operating on patients who were nontobacco users with a body mass index >18.5 kg/m2 and <40 kg/m2. Surgeons were assigned a risk- and reliability-adjusted adherence rate which was used to divide surgeons into tertiles. Outcomes were compared between adherence tertiles. RESULTS: Across 70 hospitals in Michigan, 15,016 patients underwent ventral and incisional hernia repair, cared for by 454 surgeons. Surgeon adherence to preoperative optimization ranged from 51% to 76%. Surgeons in the lowest optimization tertile had higher rates of emergency department visits (8.78% versus 7.05% versus 7.03%, P < 0.001), serious complications (2.12% versus 1.56% versus 1.84%, P = 0.041), and any complication (4.08% versus 3.37% versus 4.04%, P = 0.043), than middle and high optimization tertiles. CONCLUSIONS: Surgeons' clinical outcomes, including complication rates, are affected by the proportion of their patients who are preoperatively optimized with regard to obesity and tobacco use. These results suggest that surgeons can improve their postoperative outcomes by addressing these issues before surgery.

Hearing Outcomes of a New Cartilage Conduction Device vs Bone Conduction Devices.

OBJECTIVE: To compare audiometric outcomes of a new cartilage conduction hearing device (CCD) with traditional bone conduction hearing devices (BCDs). STUDY DESIGN: Clinical trial and crossover study design. SETTING: Tertiary academic center. METHODS: Sixteen adults (19 ears) with congenital aural atresia or overclosed ear canals who previously underwent BCD implantation were fitted with a CCD. Audiometric data were collected with use of the BCD and the CCD. RESULTS: The mean pretreatment 4-frequency pure tone average was 81 dB. The mean aided pure tone averages with the BCD and CCD were 27 and 32 dB (P = .002), and the mean functional gains were 54 and 49 dB (P = .002), respectively. The mean consonant-nucleus-consonant scores with the BCD were 90% (best aided) and 80% (aided ear isolated), and those with the CCD were 86% and 76%. Mean AzBio scores were 90% (quiet), 77% (+10 dB SNR [signal to noise ratio]), and 52% (+5 dB SNR) when isolating the BCD ear and 90%, 73%, and 41% when isolating the CCD ear. No difference in speech scores achieved statistical significance except the AzBio isolated to the aided ear in the +5-dB SNR condition, which favored the BCD (P = .01). CONCLUSION: Pure tone audiometric outcomes with the BCD show a small advantage over the CCD, with the difference driven mainly by high-frequency responses. Speech outcomes were equivalent apart from the +5-db SNR condition, which favored the BCD.