Development and Assessment of an Otolaryngology-Specific Surgical Priority Scoring System.

OBJECTIVE: To develop and assess an otolaryngology-specific surgical priority scoring system that incorporates varying levels of mucosal involvement. STUDY DESIGN: Retrospective cohort. SETTING: Academic medical center. METHODS: A novel mucosal score was developed based on best available evidence. This mucosal score was incorporated into the Medically Necessary, Time-Sensitive (MeNTS) score to generate a MeNTS-Mucosal (MeNTS-M) score. A retrospective cohort of patients was identified to assess the surgical priority scoring systems. Inclusion criteria included all scheduled surgical procedures between March 23, 2020, and April 17, 2020. Decisions about whether to proceed or cancel were made based on best clinical judgment by surgeons, without use of any surgical priority scores. The predictive value of the surgical priority scoring systems was assessed in this retrospective cohort. RESULTS: The median MeNTS score was significantly lower in adult patients whose surgery proceeded compared to those for whom the surgery was cancelled (48 vs 56; P = .004). Mucosal and MeNTS-M scores were not statistically different based on whether surgery proceeded. Among adult patients, the highest area under the curve (AUC) was for the MeNTS scoring system (0.794); both the mucosal and MeNTS-M systems had lower AUC values (which were significantly lower than the AUC for the MeNTS scoring system). CONCLUSION: This study represents development and assessment of the first otolaryngology-specific surgical priority score and incorporates varying levels of mucosal disruption. The combined MeNTS-M scoring system could be a valuable tool in appropriately triaging otolaryngology-head and neck surgery procedures.

Patient-Reported Outcomes in Sinonasal and Skull Base Malignancy: An Assessment of Study Quality and Clinical Relevance.

BACKGROUND: Sinonasal and skull base malignancies can cause significant adverse effects on functional status and survival. OBJECTIVE: The goal of this study was to systematically review the published literature of patient-reported outcomes pertaining to treatment of sinonasal and skull base malignancy. METHODS: A systematic literature search of Medline was conducted with PubMed to identify studies that assessed patient-reported outcomes in patients with sinonasal or skull base malignancy. Patient-reported outcomes studies with at least 10 patients published in English from January 2000 to April 2017 were included. Criteria from International Society for Quality of Life guidelines and criteria unique to sinonasal and skull base malignancies were used to calculate a composite score for each article. Studies with the top 33% of scores were categorized as high quality articles. RESULTS: Twenty-two articles met inclusion/exclusion criteria. Three studies (14%) reported a priori hypothesis. Eleven (50%) assessed specific quality of life domains and 10 studies (45%) performed statistical analysis on these domains. Specific symptoms were assessed in up to 32% of studies. Eight studies were characterized as high quality; these studies had higher sample sizes and more often assessed patient-reported outcomes prior to treatment compared to low quality studies. CONCLUSIONS: The goal of the current study was to evaluate the quality of the current patient-reported outcomes literature on sinonasal and skull base malignancies. Areas of improvement for future studies include analysis of individual domains and disease-specific symptoms, reporting a priori hypotheses, and collecting preoperative and longitudinal patient-reported outcomes data.

Factors Associated With Patient Nonattendance in Rhinology Clinics.

BACKGROUND: Nonattendance to clinical appointments is a global problem appreciated by clinicians with an ambulatory presence. There are few reports of nonattendance in otolaryngology clinics, and no reports on nonattendance for a single otolaryngology subspecialty. OBJECTIVE: To describe the no-show population in rhinology clinics. METHODS: A retrospective chart review was performed involving rhinology clinics from 2 academic medical centers in the United States. All patients who either attended their clinic appointment(s) or did not attend without previously cancelling from June 2016 to May 2017 were included. Data collected included patient demographics, appointment status, season and time of visit, insurance status, type of visit (new vs established), and provider seen. RESULTS: There were 2791 clinical appointments evaluated over a 12-month period at 2 rhinology clinics involving 4 fellowship-trained rhinologists. Ninety-two percent of patients kept their appointments, while 8% did not. Sex, season of visit, time of visit (am vs pm), type of visit, provider sex, provider location, or provider's experience (<10 years vs ≥10 years) were not associated with patient's attendance status. Univariate analysis showed that patient's age ≤50 ( P = .001) and primary insurance type ( P < .001) were associated with nonattendance. Medicaid as the primary insurance type was associated with clinic nonattendance. Multivariable analysis showed that age ≤ 50 years, odds ratio (OR) 1.62 (95% confidence interval [CI] 1.14-2.30), P = .007, and primary insurance type (Medicaid: OR 3.75 [95% CI 2.58-5.45], P < .001) remained significant predictors of nonattendance. CONCLUSION: Patients younger than 50 years and patients with Medicaid as the primary insurance types are associated with risk of missing rhinology clinic appointments. As a subspecialty, delivery of timely care and clinical efficiency could be improved by interventions directed toward improving attendance among this population.