Lumber drain morbidity in endonasal endoscopic skull base surgery.

The purpose of this study is to describe the morbidity in patients undergoing endoscopic skull base surgery (ESBS) with and without intra-operative lumbar drain (LD) placement. A retrospective review of all patients undergoing ESBS from July 2018 to August 2020 at a tertiary academic skull base surgery program was conducted. Those with LD placement for aiding in suprasellar dissection and/or for CSF diversion following skull base repair were included. LD-related medical and technical complications were combined as composite outcomes to assess overall event rates in those with and without LD. 104 patients were included. Of the 104 participants, 64 (61.5%) had LD placed. Of these 64, 1 (0.96%) and 2 (1.9%) experienced postoperative medical (hypophysitis) and related technical (2 blood patches) complications, respectively. There was one case of postoperative CSF leak (in LD group) and no cases of DVT/PE or meningitis. LD use was not associated with increased risk of any complication (p = 0.165) compared to those without LD. There were no significant differences in rates of postoperative epistaxis (p = 0.427), readmission (p = 0.629), or reoperation (p = 0.165) between groups. Female sex was the only predictor of increased overall complication rates in patients with LD (OR, 1.122, 95% CI, 1.010-1.247, p = 0.032). Our findings suggest judicious use of a LD in endoscopic skull base surgery within a reasonable time does not increase the incidence of overall medical or technical complications, readmission, and reoperation.

See many, do one, teach many more: Assessing quality and reliability of publicly available endoscopic videos in rhinology.

OBJECTIVES: The use of video recording is commonplace in rhinology given the increased use of endoscopes when evaluating patients in the office and the operating room and for its educational potential. This study aimed to determine the quality of publicly available endoscopic videos in rhinology. METHODS: A video search was performed on YouTube in April 2020 and included all videos since its inception in 2005 using terms related to rhinology found in the Accreditation Council for Graduate Medical Education (ACGME) Case Log Coding Guide. Videos which met inclusion criteria were evaluated for video metrics and quality using validated scoring systems: Video Power Index (VPI), modified Journal of American Medical Association (JAMA) benchmark criteria, modified global quality score (GQS), and modified DISCERN criteria. RESULTS: A total of 138 videos were evaluated, 114 of which were uploaded independently, and 24 videos were uploaded by an academic institution. Academic-affiliated videos have higher like ratio at 91.7 ± 7.55% compared with 86.27 ± 17.44% (p = 0.018). Academic-affiliated videos have higher JAMA benchmark scores, DISCERN criteria scores, and GQS values (1.71 ± 0.55 vs. 1.66 ± 0.49 [p = 0.66]), (3.33 ± 0.56 vs. 2.85 ± 0.65 [p < 0.001]), (4.38 ± 0.81 vs. 3.43 ± 1.01 [p < 0.001])], respectively. There was no significant difference in VPI (p = 0.73). CONCLUSIONS: Endoscopic videos are rapidly growing in prominence and remain an important part of surgical education, but overall are heterogeneous in quality and reliability, necessitating an effort to establish both video sharing regulations and objective standards of quality.

Predictors of Postoperative Nausea and Vomiting After Endoscopic Skull Base Surgery.

OBJECTIVES/HYPOTHESIS: The objective of this study is to evaluate the impact of patient and surgical factors, including approach and reconstruction type, on postoperative nausea and vomiting episodes following endoscopic skull base surgery. STUDY DESIGN: Retrospective review. METHODS: We performed a retrospective chart review from July 2018 to August 2020 of 99 consecutive patients undergoing endoscopic skull base surgery at a tertiary academic skull base surgery program. All patients were treated with a standardized postoperative protocol consisting of scheduled ondansetron, along with promethazine and scopolamine for breakthrough nausea and vomiting episodes. Cumulative nausea and vomiting episodes throughout hospital stay were recorded for each patient. RESULTS: Of the 99 patients identified, the mean number of nausea and vomiting episodes per patient were 0.4 ± 1.2 and 0.3 ± 0.7, respectively. Female sex (ß = .65, P = .034) and extended surgical approach (ß = .90, P = .027) were associated with increased risk for postoperative nausea. Furthermore, female sex (ß = .44, P = .018), cavernous sinus dissection (ß = .52, P = .002), and extended approach (ß = .79, P = .025) significantly increased odds of postoperative vomiting episodes. There was no association between total operative time or total postoperative opioid dose and nausea and vomiting episodes (all Ps > .05). Neither increased nausea nor vomiting episodes significantly increased odds of prolonged hospitalization (P = .105 and .164, respectively). CONCLUSION: This report highlights novel risk factors for patients undergoing endoscopic skull base surgery. Upfront standing antiemetic therapy may be considered when treating patients with independent predictors of postoperative nausea and vomiting, including female sex, cavernous sinus dissection, and extended surgical approach. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:761-768, 2022.