Cold Technique in Adult Tonsillectomy Reduces Waste and Cost.

OBJECTIVES: To quantify differences in waste and cost of disposable equipment between different tonsillectomy techniques. METHODS: Prospective study of waste attributable to disposable waste produced by tonsillectomy surgery. Disposable equipment required for tonsillectomy using cold, monopolar electrocautery (ME), and coblation techniques was measured; and differences in mass, volume, and cost of equipment between the 3 techniques were quantified. RESULTS: Cold technique was found to produce the least waste and have the lowest cost attributable to disposable surgical equipment. Projected single-case savings in mass and volume of waste resulting from using cold technique compared to ME were 1.272 kg and 1.013 L, respectively, and 1.043 kg and 1.723 L compared to coblation. Projected single-case savings in cost of disposable equipment for cold technique compared to ME were US$9.35 and US$185.05 compared to coblation. DISCUSSION: Using cold technique for adult tonsillectomy reduces waste and cost of disposable equipment compared to ME and coblation. Implications for Practice: Surgeons desiring to reduce cost and waste associated with tonsillectomy surgery may consider transitioning to cold technique.

Managing Seborrheic Keratosis: Evolving Strategies and Optimal Therapeutic Outcomes.

Seborrheic keratosis (SK) is the most common skin tumor seen by dermatologists in everyday practice. Although the lesions are mostly benign, many patients still elect to have asymptomatic SK removed. The historical standards of treatment are cryosurgery and electrocautery, two surgical options that are effective at lesion removal but have high rates of postoperative adverse events such as treatment-site scarring and pigmentary alterations. The cosmetic outcomes of SK treatment modalities are of keen interest to dermatologists, as the American population becomes increasingly more diverse. In this article, the inclusion of darker Fitzpatrick skin types into clinical studies investigating post-treatment side effects of SK therapy is reviewed. The recent approval of a 40% hydrogen peroxide topical formulation is discussed in light of these issues, and several non-invasive topical treatments that optimize cosmetic outcomes of SK lesion removal are highlighted. Finally, treatment strategies aimed at reducing cost and minimizing the burden of adverse sequelae are provided. J Drugs Dermatol. 2018;17(9):933-940.

Prevalence and management of recurrent respiratory papillomatosis (RRP) in the UK: cross-sectional study.

OBJECTIVES: To estimate the number of patients with recurrent respiratory papillomatosis currently managed in secondary and tertiary health care in the UK and the frequency of its treatment with radiofrequency cold ablation (Coblation™ ). DESIGN: Cross-sectional survey of ENT consultants in the UK with validation using Hospital Episode Statistics (HES) inpatient data. SETTING: Online survey. PARTICIPANTS: ENT consultants in the UK. MAIN OUTCOME MEASURES: Number of recurrent respiratory papillomatosis patients currently managed in acute care in the UK and frequency of use of Coblation. RESULTS: A total of 283 ENT consultants from 128 UK NHS healthcare trusts and health boards completed the online survey. Responses were received from 86% of surveyed organisations, and an estimated 45% of all ENT consultants in UK. The estimated number of recurrent respiratory papillomatosis patients from the cross-sectional survey was 918 (at August 2015) which included 730 patients in England. The number of recurrent respiratory papillomatosis patients in England estimated from Hospital Episode Statistics (2014/15 financial year) was up to 741. A total of 42 Coblation procedures conducted in the UK were identified from the cross-sectional survey; 36 were conducted in England compared with 34 identified from Hospital Episode Statistics. CONCLUSIONS: The numbers of recurrent respiratory papillomatosis patients and Coblation procedures identified in England from a cross-sectional survey and Hospital Episode Statistics were in broad agreement. Our study estimated 1.42 recurrent respiratory papillomatosis patients per 100 000 in the general UK population. We also estimated that Coblation procedures accounted for 3% of interventional treatments conducted in the UK recurrent respiratory papillomatosis population.

Comparison of resource utilization of pulmonary vein isolation: cryoablation versus RF ablation with three-dimensional mapping in the Value PVI Study.

BACKGROUND: Point-to-point focal radiofrequency (RF) catheter ablation for aberrant pulmonary vein triggers that manifest into atrial fibrillation (AF) is the traditional method for treating symptomatic drug-resistant paroxysmal AF (PAF) when an ablation procedure is warranted. More recently, pulmonary vein isolation (PVI) using the cryoballoon has been demonstrated to be safe and effective (STOP AF clinical trial). Currently, two small studies have reviewed the procedural efficiency when comparing cryoballoon to focal RF catheter ablation procedures; however, no multicenter study has yet reported on this comparison of the two types of ablation catheters. METHODS: A multicenter retrospective chart extraction and evaluation was conducted at seven geographically mixed cardiac care centers. The study examined procedural variables during ablation for PVI in PAF patients. RESULTS: In several procedural measurements, the two modalities were comparable in efficiencies, including: acute PVI >96%; length of hospital stay at approximately 27 hours; and about 30% usage of adenosine after procedural testing. However, when compared to RF catheters, the cryoballoon procedure demonstrated a 13% reduction in laboratory occupancy time (247 min vs 283 min), a 13% reduction in procedure time (174 min vs 200 min), and a 21% reduction in fluoroscopy time (33 min vs 42 min). Additionally, when comparing the material usage of both cryoballoon and RF catheters, the cryoballoon used more radiopaque contrast agent (78 cc vs 29 cc) while using less intraprocedural saline (1234 cc vs 2386 cc), intracardiac echocardiography (88% vs 99%), three-dimensional electroanatomic mapping (30% vs 87%), and fewer transseptal punctures (1.5 vs 1.9). CONCLUSION: This study is the first United States multicenter examination to report the procedural comparisons between the cryoballoon and focal RF catheters when used for the treatment of PAF patients. In this hospital chart review study, potential advantages were found when operating the cryoballoon with regard to hospital resource allocation. There was no statistical difference between cryoballoon and RF catheters for acute PVI success during the ablation procedure.

Broad overview of a clinical and commercial experience with CoolSculpting.

BACKGROUND: Cryolipolysis has been shown to be a safe and effective noninvasive procedure for the reduction of localized subcutaneous fat. OBJECTIVES: The authors examine the safety, efficacy, and procedural growth of cryolipolysis (via the CoolSculpting device; Zeltiq, Pleasanton, California) in a single plastic surgery practice. METHODS: A retrospective chart review was conducted for 528 consecutive patients who underwent cryolipolysis treatment from January 2010 to December 2012. The number of patients, the number of treatment cycles, the average number of cycles per patient, all treatment areas, and all procedural complications were recorded and analyzed. Overall practice growth with the device was also analyzed. RESULTS: Over the study period, 1785 anatomic sites were treated with 2729 cycles, primarily in the lower abdomen (28%, n = 490 cycles), upper abdomen (11%, n = 189), left flank (19%, n = 333), right flank (19%, n = 333), inner thigh (6%, n = 111), outer thigh (5%, n = 87), and back (6%, n = 99). The age distribution for men and women was similar (46.6 ± 12.8 years for women and 46.5 ± 12.3 years for men; overall range, 18-79 years). Only 3 cases of mild or moderate pain/neuralgia were reported and resolved in 4 or fewer days. No adverse events were reported. Procedure volume showed consistent growth, with treatment cycles increasing by 823% by 2012. CONCLUSIONS: Based on the results in this single plastic surgery practice, cryolipolysis is a safe and effective nonsurgical body contouring method associated with high patient satisfaction that can generate steady, significant business growth.

Regional practice patterns for retinal detachment repair in the United States.

PURPOSE: To determine if there are variations in regional practice patterns for retinal detachment repair in the United States. DESIGN: Retrospective, noninterventional, cross-sectional study. METHODS: Year 2009 Medicare fee-for-service claims for retinal detachment repair were aggregated in 4 geographic regions and evaluated. The relative preference for retinal detachment repair by pars plana vitrectomy, scleral buckling, and pneumatic retinopexy was analyzed. RESULTS: The Midwest demonstrated a greater preference for scleral buckling compared to all other regions (P < .01) and lower preference for pars plana vitrectomy relative to the South and West (P ≤ .02). The Northeast demonstrated a greater preference for pneumatic retinopexy when compared to all other regions (P < .01). The Northeast also revealed a trend toward a lower preference for pars plana vitrectomy compared to the West and South (P ≤ .08). CONCLUSION: There are statistically significant variations in regional practice patterns for retinal detachment repair. The West, despite its historical association with pneumatic retinopexy, did not demonstrate a greater preference for the surgical technique.

Time to treatment of prostate cancer through the Calgary Prostate Institute rapid access clinic.

PURPOSE: To determine the wait time between initial referral, biopsy, diagnosis and individual treatment modalities of prostate cancer treatment through the Calgary Prostate Institute rapid access clinic (RAC) and compare to historical data estimates in Alberta and to suggested standards. Biopsy rate, rate of confirmed prostate cancer and the distribution of treatment modality for patients seen through the RAC is included. MATERIALS AND METHODS: A non-consented, retrospective chart review of 1103 patients from the Calgary Health Region referred to the RAC between September 2005 and August 2006 was completed. RESULTS: Patients experienced a median wait time of 21 days between referral from their family doctor and prostate biopsy. A total of 31.4% of patients referred to the clinic were requested to have a prostate biopsy performed and 50.8% of biopsies resulted in confirmed prostate cancer requiring treatment. Median wait time between diagnosis and treatment for all treatment types was 52.0 days with a 90th percentile of 146.2 days. Median wait time between referral and treatment for all treatment modalities was 101 days with a 90th percentile of 187.2 days. CONCLUSION: Calgary rapid access clinic reduces wait time between referral and biopsy by 78%. Stratifying across treatment type indicates that watchful waiting is the shortest time duration and radiation with hormone therapy is the longest.

Alternative cervical cancer prevention in low-resource settings: Experiences of visual inspection by acetic acid with single-visit approach in the first five provinces of Thailand.

BACKGROUND: After the confirmation of its safety, acceptability and feasibility in a cervical cancer prevention demonstration project in 2002, a visual inspection by acetic acid (VIA) followed by an effective treatment using cryotherapy as a single-visit approach (SVA) was recently introduced in five provinces having low Pap smear screening rates, in Thailand. The effectiveness of a screening program is usually associated with a high level of coverage; however, in low-resource settings such a high coverage is still hard to attain by the conventional Pap smear approach. AIMS: To evaluate whether VIA/SVA can increase women's access to the prevention services in low-resource provinces of Thailand. METHODS: A cross-sectional study was conducted by analysing electronic screening records of the provinces. A chi2 test was used in the comparisons of screening coverage between the year before and the first year of VIA/SVA implementation during 1998-2005. RESULTS: This comparative study, which included 88 554 screening visits totally, shows a significant increase in the screening coverage of five provinces after the VIA/SVA implementation (P < 0.001). As a result of the large substitution of VIA/SVA for Pap smears, the costs of screening were lowered by as much as $US362,300 (66.8%) in the first year. CONCLUSION: VIA/SVA has provided good screening coverage and lowered the financial burden in five low-resource provinces of Thailand. Therefore, it is promisingly competitive as a potential alternative means of cervical cancer prevention in low-resource areas.

Treatment of basal cell carcinomas by general practitioners in Australia.

BACKGROUND: Basal cell carcinomas (BCCs) are a relatively common form of skin damage in Australians, involving approximately 1 in 200 general practice encounters per year. AIM: To determine current treatments and the associated healthcare resource costs of BCC therapy in Australia. METHODS: A retrospective survey was undertaken relating to the treatment of patients presenting to their doctor with previously untreated BCCs. Data were collected from a sample of general practitioners who were asked to randomly select two BCC patients from their medical records and complete a questionnaire. Information about treatment types, number of doctor visits, treatment complications, and specialist referrals was extracted from the patient records. RESULTS: One hundred and sixty-four patients were recruited into the study (59% male), who were treated for a total of 244 BCCs (average of 1.5 lesions per patient). Twenty-two per cent of patients were referred to a specialist, most being referred to a general surgeon (45%) or plastic surgeon (25%). Excision was the preferred therapy; second choices were cryosurgery or curettage and cautery. Few adverse events were recorded. The typical number of doctor visits varied from 3.2 to 7.4, with a range of total cost per patient of 146.60-496.20 AUS dollars, depending on complexity and the need for referral. CONCLUSION: With a reported incidence in Australia of approximately 788 per 100,000 persons, BCCs are not inexpensive to treat for such a relatively common condition.