Correlation Between Intolerance of Uncertainty and Post-Operative Regret in Otolaryngology Patients.

OBJECTIVE: To determine if intolerance of uncertainty, depression, anxiety, worry, or stress are related to post-op regret in otolaryngology patients. METHODS: Adult patients or parents giving consent for pediatric patients meeting criteria for otolaryngologic surgery were recruited and completed the Intolerance of Uncertainty Scale (IUS-12), Penn State Worry Questionnaire (PSWQ), and Depression, Anxiety and Stress Scale-21 (DASS-21) preop and the Decisional Regret (DR) scale 1-month post-op. Pearson correlations were calculated. RESULTS: The cohort included 109 patients, 73 (67%) males and 36 (33.3%) females. 43 (39.5%) were college graduates and 66 (60.9%) were not. Mean IUS-12 score was 22.9 (95% CI 21.0-24.8), mean PSWQ score was 46.9 (95% CI 44.5-49.3). DASS-21 mean score was 11.9 (95% CI 9.6-14.3). Mean DR score was 11.1 (95% CI 8.6-13.6). IUS-12 subscales Prospective Anxiety mean score was 14.2 (95% CI 12.8-15.5) and Inhibitory Anxiety mean score was 16.5 (95% CI 14.5-18.6). The Pearson correlation coefficient for post-op DR and total preop IUS was .188 (P = .027) and the correlation coefficient for post-op DR and preop Prospective Anxiety subscale of IUS score was .174 (P = .037). Correlations with PSWQ and DASS-21 scores and DR were not statistically significant. CONCLUSION: Intolerance of uncertainty is a psychological construct that is associated with post-op DR. More work is needed to determine whether screening for IU and behavior modification directed at IU for those with high levels would improve post-op decisional regret.

Depression and Intolerance of Uncertainty: Association with Decisional Conflict in Otolaryngology Patients.

OBJECTIVE: To determine if anxiety, stress, depression, worry, and intolerance of uncertainty were related to pre-operative decisional conflict (DC), shared decision making (SDM), or demographic variables in adult otolaryngology surgical patients. METHODS: Consecutive adult patients meeting criteria for otolaryngological surgery were recruited and completed DC and SDM scales, Penn State Worry Questionnaire (PSWQ), Intolerance of Uncertainty Scale (IUS-12), and Depression, Anxiety and Stress Scale-21 (DASS-21). RESULTS: The cohort included 118 patients, 61 (51.7%) males and 57 (48.3%) females. Surgery was planned for a benign process in 90 (76.3%) and 46 (39.3%) had previous otolaryngologic surgery. SDM and DC scores did not significantly differ across gender, age, education level, previous otolaryngologic surgery or whether or not surgery was for malignancy. Patients with no malignancy had significantly higher DASS-21 Stress scores (mean 12.94 vs 8.15, P < .05) and total IUS-12 scores (mean 28.63 vs 25.56, P = .004). Women had lower PSWQ scores (41.56 vs 50.87 for men, P = .006). IUS-12 and PSWQ declined with age. DC scores correlated positively with DASS-21 Depression (r = .256, P = .008) and IUS-12 scores (r = .214, P = .024). SDM correlated negatively with DASS-21 Depression (r = -.208, P = .030). Linear regression model for DC scores revealed a significant relationship with DASS depression (B = 0.674, P = .048). CONCLUSION: Preoperative decisional conflict is associated with increased depression and intolerance of uncertainty in adults undergoing otolaryngologic surgery. Screening for and management of depression, anxiety, and related concerns may improve surgical outcomes in this group.

Shared Decision Making: The 9-Item Shared Decision Making Questionnaire Does Not Discriminate Between Surgeons.

Purpose To determine if shared decision making (SDM) scores vary between individual otolaryngologists in a large specialty clinic.  Methods Consecutive patients that consented to surgery were surveyed using the 9-item Shared Decision Making Questionnaire (SDM-Q-9), a validated scale for SDM. Demographic details included the respondent's age, gender, education level, marital status, whether the consent was for themselves or their child, whether surgery was for malignancy, and surgery being performed. Scores were evaluated for all demographic variables, as well as individual surgeons, surgeons' gender, age category, and subspecialty. Results A total of 233 patients completed the surveys. No significant differences were found among individual and total scores for SDM when compared among or between patient demographics (p > 0.05). A total of 10 surgeons for whom five or more SDM-Q-9s were completed were included in the study. No significant difference was found when SDM was evaluated for surgeon characteristics as well (p > 0.05).  Conclusion SDM scores do not vary between these otolaryngologists.

Airway foreign bodies in pediatric patients: An analysis of composition and age via HCUP KID.

OBJECTIVE: To compare outcomes for children food and non-food airway foreign body (AFB) diagnoses and to compare outcomes for patients age <2 versus ≥2 years with an AFB diagnosis. METHODS: Data from 2016 HCUP KID was used to compare outcomes for food and non-food AFB diagnoses based on location in the larynx, trachea, bronchus, and whole group (including these three specified locations and location unspecified). Outcomes were also compared for children aged <2 versus ≥2 years. Demographic data included age, race, gender, primary payer, location and teaching status of the hospital. Available co-morbidity data included APR-DRG mortality and APR-DRG severity. Outcomes were length of stay (LOS), total charge, mortality, and performance of a tracheotomy. RESULTS: 2973 patients were included. 49.1% were less than 2 years old, the remainder (50.9%) were between 2 and 20 years old. Food AFBs made up 26.0% and 74.0% were other specified non-food AFBs. Overall mortality was 3.7%, and 3.8% underwent tracheotomy. Children with non-food AFBs were significantly older, had significantly longer median LOS, and higher median total charges, when compared to food AFBs. Non-food AFBs had a significantly higher likelihood of tracheotomy. Patients aged 2 or more years with bronchial AFBs had significantly higher total charges, LOS, and APR-DRG risk mortality and severity than <2 year old patients with bronchial AFBs. CONCLUSION: AFBs remain a serious health concern, especially non-food objects in older children which have elevated risks.

Program Directors' Opinions About Otolaryngology Resident Teaching Medical School Anatomy.

Purpose To evaluate whether otolaryngology residency program directors (PDs) provide residents to teach pre-clinical medical students anatomy and to outline their perceptions of this practice. Methods An anonymous online survey was sent to active U.S. otolaryngology residency PDs in 2019, assessing each program's involvement in teaching medical student anatomy. Results Forty-five of 121 (37.1%) of surveyed otolaryngology PDs responded. Sixteen of the 44 (36.4%) residency programs that were associated with a medical school provided residents to teach anatomy ("Teaching Programs"). The 29 (64.4%) remaining programs did not provide residents ("Non-teaching Programs"). No significant differences were found between Teaching and Non-teaching Programs (P<0.05) for the size of the program, the presence of fellowships, the size of medical school, whether residents had won teaching awards, or the number of otolaryngology residency applicants from that school. In general, all PDs responded positively about residents teaching medical school anatomy. Non-teaching Programs primarily cited not being approached by the medical school as a reason for not providing residents to teach. Conclusion The majority of respondent otolaryngology PDs have a positive view of residents teaching medical students but few do it. Otolaryngology departments will need to take the lead on developing opportunities to put students and residents together for anatomy education.