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2.
Mil Med ; 2022 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-35134214

RESUMO

INTRODUCTION: While risk factors for severe COVID-19 infections have been well explored among the public, population-specific studies for the U.S. Veteran community are limited in the literature. By performing a comprehensive analysis of the demographics, comorbidities, and symptomatology of a population of COVID-19 positive Veterans Affairs (VA) patients, we aim to uncover predictors of death, survival, need for intubation, and need for nasal cannula oxygen support among this understudied community. MATERIALS AND METHODS: A retrospective review was conducted of 124 COVID-19 Veteran patients who were admitted from March to October 2020 to the VA Greater Los Angeles Healthcare System (IRB#2020-000272). Chi-square and Fisher's exact tests were employed to assess differences in baseline demographic and clinical variables between Veterans who survived COVID-19 versus those who succumbed to COVID-19 illness. Multivariate logistic regression and Cox regression analyses were employed to assess predictors of outcome variables, including death, survival, need for intubation, and need for oxygen support (via nasal cannula). Covariates included a wide range of demographic, comorbidity-related, symptom-related, and summary index variables. RESULTS: Our study population consisted of primarily senior (average age was 73) Caucasian and African American (52.5% and 40.7%, respectively) Veterans. Bivariate analyses indicated that need for intubation was significantly associated with mortality (P = 0.002). Multivariate analyses revealed that age (P < 0.001, adjusted odds ratio (OR) = 1.16), dyspnea (P = 0.015, OR = 7.73), anorexia (P = 0.022, OR = 16.55), initial disease severity as classified by WHO (P = 0.031, OR = 4.55), and having more than one of the three most common comorbidities (hypertension, diabetes, and cardiac disease) and symptoms (cough, fever, and dyspnea) among our sample (P = 0.009; OR = 19.07) were independent predictors of death. Furthermore, age (P < 0.001, hazard ratio (HR) = 1.14), cerebrovascular disease (P = 0.022, HR = 3.76), dyspnea (P < 0.001, HR = 7.71), anorexia (P < 0.001, HR = 16.75), and initial disease severity as classified by WHO (P = 0.025, HR = 3.30) were independent predictors of poor survival. Finally, dyspnea reliably predicted need for intubation (P = 0.019; OR = 29.65). CONCLUSIONS: Several independent predictors of death, survival, and need for intubation were identified. These risk factors may provide guidelines for risk-stratifying Veterans upon admission to VA hospitals. Additional investigations of COVID-19 prognosis should be conducted on the larger U.S. Veteran population to confirm our findings and add to the current body of literature.

3.
Artigo em Inglês | MEDLINE | ID: mdl-35019237

RESUMO

INTRODUCTION: Topical steroids are a mainstay in the treatment of chronic rhinosinusitis (CRS). Multiple delivery methods of topical steroids following sinus surgery have been investigated. The purpose of this trial is to evaluate the effect of triamcinolone-impregnated absorbable nasal packing on healing following endoscopic sinus surgery (ESS). METHODS: This is a prospective, randomized, double-blind, placebo-controlled trial. A total of 22 subjects (14 without polyps and eight with polyps) were enrolled and were randomized to receive triamcinolone-impregnated packing in one sinus cavity and normal saline-soaked packing in the contralateral sinus cavity. Endoscopic evaluation was completed at the first two postoperative visits, and Lund-Kennedy (LK) endoscopic scores and perioperative sinus endoscopy (POSE) scores were calculated at each visit. RESULTS: The results of this study found no significant difference in the appearance of the sinuses at either postoperative visit. Mean LK scores for the triamcinolone and saline groups at the first and second postoperative visits were 2.09 ± 1.23 versus 2.18 ± 1.01 (p = 0.79) and 1.79 ± 1.08 versus 1.68 ± 1.16 (p = 0.77), respectively. POSE scores were 2.59 ± 1.71 versus 2.68 ± 1.62 (p = 0.86) and 1.74 ± 1.15 versus 1.95 ± 1.22 (p = 0.59). CONCLUSION: The results of this study demonstrated no significant difference in healing, crusting, polyps, edema, or secretions between the triamcinolone-treated and non-triamcinolone-treated sinuses. There were no adverse effects from the use of triamcinolone-impregnated absorbable packing. Further studies will be necessary to determine the impact of triamcinolone-impregnated absorbable packing following ESS.

4.
Curr Treat Options Allergy ; 9(1): 1-18, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35004126

RESUMO

Purpose of Review: Olfactory dysfunction is a frequent complication of SARS-CoV-2 infection. This review presents the current literature regarding the management of post-COVID-19 olfactory dysfunction (PCOD). Recent Findings: A systematic review of the literature using the PubMed/MEDLINE, EMBASE, and Cochrane databases for the following keywords, "Covid-19," "SARS-CoV-2," "anosmia," "olfactory," "treatment," and "management" was performed. While most cases of post-COVID-19 olfactory dysfunction resolve spontaneously within 2 weeks of symptom onset, patients with symptoms that persist past 2 weeks require medical management. The intervention with the greatest degree of supporting evidence is olfactory training, wherein patients are repeatedly exposed to potent olfactory stimuli. To date, no large-scale randomized clinical trials exist that examine the efficacy of pharmacologic therapies for PCOD. Limited clinical trials and prospective controlled trials suggest intranasal corticosteroids and oral corticosteroids may alleviate symptoms. Summary: Olfactory training should be initiated as soon as possible for patients with PCOD. Patients may benefit from a limited intranasal or oral corticosteroid course. Further research on effective pharmacologic therapies for PCOD is required to manage the growing number of patients with this condition.

5.
Laryngoscope ; 132(5): 926-932, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34232507

RESUMO

INTRODUCTION: Prior studies suggest that there may be a link between human papillomavirus (HPV) infection and malignant sinonasal inverted papilloma (SNIP). This systematic review and meta-analysis was performed to further evaluate this potential association. STUDY DESIGN: Systematic review with meta-analysis. METHODS: The Medline and Embase databases were used to identify case-control studies reporting the risk of malignant SNIP in patients with high-risk HPV subtypes identified by polymerase chain reaction (PCR). Meta-analysis was performed to determine pooled odds ratios (ORs) and 95% confidence intervals (CI). RESULTS: Twenty-one studies were identified, including a total of 841 subjects with SNIP. Seventeen studies were included in the final analysis, as four studies did not have any HPV-positive tumors in either group. A total of 56 malignant SNIP and 551 benign SNIP were ultimately identified. The pooled log-OR was 1.80 (95% CI: 1.03-2.57) for all high-risk HPV subtypes. Stratification by high-risk HPV subtype showed a log-OR of 1.67 (95% CI: 0.88-2.46) for HPV-16 and log-OR of 2.68 (95% CI: 1.30-4.05) for HPV-18. CONCLUSION: Infection with high-risk HPV subtypes may be associated with an increased risk of malignant SNIP. HPV-18 showed the greatest overall average effect size of the common high-risk subtypes. LEVEL OF EVIDENCE: NA Laryngoscope, 132:926-932, 2022.


Assuntos
Neoplasias Nasais , Papiloma Invertido , Infecções por Papillomavirus , Neoplasias dos Seios Paranasais , Papillomavirus Humano 18 , Humanos , Neoplasias Nasais/patologia , Papiloma Invertido/patologia , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Neoplasias dos Seios Paranasais/patologia , Reação em Cadeia da Polimerase
6.
Am J Rhinol Allergy ; 36(1): 33-40, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33910378

RESUMO

BACKGROUND: Currently, no consensus exists on the appropriate control specimen site to utilize in studies evaluating for biomarkers in chronic rhinosinusitis (CRS). Studies thus far have utilized tissue from various anatomic sites despite regional heterogeneity. OBJECTIVE: We set out to quantify the differences in biomarker levels present in inferior turbinate versus sphenoid sinus mucosa in paired healthy control patients. We hypothesize that statistically significant differences in cytokine/chemokine expression exist between these two distinct sites. METHODS: A 38-plex commercially available cytokine/chemokine Luminex Assay was performed on 54 specimens encompassing paired inferior turbinate and sphenoid sinus mucosa samples from 27 patients undergoing endoscopic anterior skull base surgery. Patients with a history of CRS were excluded. Paired sample t-tests and Fisher's exact tests were performed. RESULTS: Twenty-seven patients were included in the study, including 10 male and 17 female patients with an average age of 48 years. The following 8 biomarkers had statistically significant concentration differences between inferior turbinate mucosa and sphenoid mucosa sites: Flt-3L, Fractalkine, IL-12p40, IL-1Ra, IP-10, MCP-1, MIP-1ß, and VEGF, with all P-values <0.01. CONCLUSION: No consensus exists regarding the optimal choice of control specimen for CRS research. We present statistically significant quantitative differences in biomarker levels between paired inferior turbinate and sphenoid mucosa samples. This confirms the presence of heterogeneity between different subsites of sinonasal mucosa and highlights the need for standardization in future CRS research.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Biomarcadores , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/patologia , Pólipos Nasais/patologia , Rinite/diagnóstico , Rinite/patologia , Sinusite/diagnóstico , Sinusite/patologia , Conchas Nasais/patologia , Conchas Nasais/cirurgia
7.
J Inflamm Res ; 14: 4259-4266, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34511966

RESUMO

The role of type 2 inflammation in the pathogenesis of certain human diseases is an area of active investigation. Certain asthma, atopic dermatitis, eosinophilic esophagitis, and chronic rhinosinusitis phenotypes are characterized by a Th2 predominant inflammatory pathway and are frequently associated with comorbid conditions in patients. The purpose of this article is to review the evidence behind concurrent Th2-mediated diseases and explore how the presence of these comorbid conditions affect patient and disease outcomes.

8.
Ear Nose Throat J ; 100(6_suppl): 859S-861S, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34392735

RESUMO

Balloon sinus dilation (BSD) is a common method of relieving sinus outflow obstruction. With the rising utilization of BSD, increasing numbers of BSD-related complications have also been reported. Here, we report a case of pneumocephalus and cerebrospinal fluid leak following BSD of the frontal sinus. Additionally, a review of the literature regarding BSD complications was performed.


Assuntos
Dilatação/efeitos adversos , Seio Frontal , Doenças dos Seios Paranasais/terapia , Pneumocefalia/etiologia , Base do Crânio/lesões , Idoso , Humanos , Masculino , Neuroimagem , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/cirurgia , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Tomografia Computadorizada por Raios X
9.
Int Forum Allergy Rhinol ; 11(9): 1296-1307, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34251080

RESUMO

The goal of this American Rhinologic Society expert practice statement (EPS) is to provide clinically applicable, evidence-based recommendations regarding pain management in sinonasal surgery. This EPS was developed following the recommended methodology and approval process as previously outlined. The topics of interest included preoperative counseling, local anesthesia, use of opioids for postoperative pain, use of nonopioid medication for postoperative pain, nonsteroidal anti-inflammatory drugs and bleeding, and use of gabapentin for pain control. Following a modified Delphi approach, 6 statements were developed, 5 of which reached consensus and 1 that did not. These statements and accompanying evidence are summarized along with an assessment of future needs.


Assuntos
Analgésicos não Narcóticos , Analgésicos Opioides , Analgésicos Opioides/uso terapêutico , Consenso , Humanos , Manejo da Dor , Dor Pós-Operatória/tratamento farmacológico , Estados Unidos
10.
OTO Open ; 5(2): 2473974X211009232, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34017935

RESUMO

Although the etiology of chronic rhinosinusitis remains unknown, environmental factors including airborne pollutants and toxicants are postulated to contribute to its pathogenesis. However, the precise pathomechanisms with which environmental toxicants may contribute to chronic rhinosinusitis are not fully understood. The purpose of this pilot study is to examine the cytotoxic effects of N,N-diethyl-meta-toluamide (DEET), a commonly used pesticide, on sinonasal epithelial cells (SNECs). Sinus mucosa was obtained from 3 subjects without a history of chronic rhinosinusitis. Cultured SNECs were exposed to various concentrations of DEET (0-5 mM) for 6 days. Cell viability, proliferation, and morphologic changes were assessed using the MTT colorimetric dye assay and the Incucyte Live Cell Monitoring System. Statistically significant dose-dependent reduction in cell viability and proliferation was observed between exposure and control groups (P < .05) at all concentrations tested. Dose-dependent cellular morphological changes were also seen. These findings indicate that DEET exposure induces dose-dependent cytotoxicity in sinonasal epithelia.

12.
Otolaryngol Head Neck Surg ; 164(1): 57-66, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32746710

RESUMO

OBJECTIVE: To review the current literature regarding the role of biologics in the treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP). DATA SOURCES: PubMed/MEDLINE, EMBASE, Cochrane Review, ClinicalTrials.gov. REVIEW METHODS: We conducted a comprehensive review of the literature on clinical studies investigating the efficacy of emerging biologics in CRSwNP, with a focus on randomized controlled trials. CONCLUSIONS: There appears to be promising evidence to support the safety and efficacy of biologics in CRSwNP with and without asthma for select patients. However, additional large-scale randomized studies with longer follow-up are necessary to determine which patients would benefit the most from these novel systemic treatments. IMPLICATIONS FOR PRACTICE: Chronic rhinosinusitis with nasal polyposis refractory to medical and surgical therapy remains a challenging clinical problem for otolaryngologists. However, emerging biologic therapies may offer a new therapeutic option for such patients with recalcitrant disease.


Assuntos
Produtos Biológicos/uso terapêutico , Pólipos Nasais/tratamento farmacológico , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Asma/complicações , Doença Crônica , Humanos , Pólipos Nasais/complicações , Rinite/complicações , Sinusite/complicações
13.
Laryngoscope ; 131(5): E1422-E1428, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33098341

RESUMO

OBJECTIVES: To characterize the incidence, causes, risk factors, and costs of 30-day readmission after inpatient functional endoscopic sinus surgery (FESS) for patients with chronic rhinosinusitis. STUDY DESIGN: Retrospective cohort study. METHODS: The Nationwide Readmissions Database was used to characterize readmission after inpatient sinus surgery for chronic rhinosinusitis from 2015 to 2017. International Classification of Disease codes were used to identify the patient population, which included 5,644 patients. Incidence, causes, costs, and predictors of readmission were analyzed and determined. RESULTS: Among 6,386 patients who underwent inpatient FESS, 742 (11.6%) were readmitted within 30 days of discharge. On univariate analysis, patients who were readmitted were more commonly older than 70 years (23.3% vs. 16.2%); had a higher burden of comorbidities including chronic kidney disease (15.0% vs. 7.8%), diabetes (25.6% vs. 20.4%), and hypertension (13.5% vs. 8.5%); had a greater rate of postoperative complications (20.7% vs. 12.2%); and had a longer length of stay (12.4 vs. 6.9 days) compared to patients who were not readmitted. Readmissions cost an additional $27,141 per patient. On multivariable analysis, age greater than 70 years, Medicaid insurance, several comorbidities, prolonged length of stay, postoperative neurologic complications, and lower hospital volume were independent predictors of 30-day readmission. The most common cause for readmission was infection (36.3%). CONCLUSION: Readmission following inpatient FESS is not uncommon. Identification and management of preoperative comorbidities, optimized patient selection for inpatient surgery, and thorough postoperative discharge care may improve patient outcomes and decrease healthcare expenditures. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E1422-E1428, 2021.


Assuntos
Endoscopia/efeitos adversos , Procedimentos Cirúrgicos Nasais/efeitos adversos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Rinite/cirurgia , Sinusite/cirurgia , Idoso , Doença Crônica/epidemiologia , Doença Crônica/terapia , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Readmissão do Paciente/economia , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Rinite/epidemiologia , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Sinusite/epidemiologia , Fatores de Tempo , Estados Unidos/epidemiologia
14.
Int Forum Allergy Rhinol ; 11(3): 213-739, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33236525

RESUMO

I. EXECUTIVE SUMMARY: BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS: ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS: ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION: This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.


Assuntos
Rinite Alérgica , Rinite , Sinusite , Consenso , Humanos , Rinite/terapia , Sinusite/terapia
15.
J Occup Environ Med ; 63(3): 262-264, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33350661

RESUMO

OBJECTIVE: Veterans of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) were exposed to high levels of pollutants resulting in increased upper and lower respiratory symptoms and morbidity. The purpose of this study is to determine the physician diagnosed prevalence of upper and lower respiratory disease in OEF/OIF veterans. METHODS: We queried the Veterans Health Administration Support Service Center database to identify veterans in the Desert Pacific Healthcare Network with International Classification of Diseases 10th Revision diagnoses related to upper respiratory and lower respiratory tract (URT and LRT) diseases and symptoms. Over 100,000 unique veterans were identified. RESULTS: OEF/OIF veterans had increased prevalence of both sinonasal disease and LRT pathology compared with non-OEF/OIF veterans. In 2016, 8.79% of OEF/OIF veterans demonstrated lower respiratory disease, which was 3.4 times greater than non-OEF/OIF veterans (P < 0.0001). Similarly, upper respiratory disease was 4.8 times more prevalent in OEF/OIF veterans, with 19.28% diagnosed compared with 3.95% of non-OEF/OIF veterans (P < 0.0001). CONCLUSION: This is the first database study that investigates the prevalence of upper airway disease in OEF/OIF veterans. Veterans serving in the post-9/11 era in Afghanistan and Iraq have a significantly increased prevalence of both lower and upper respiratory disease.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Veteranos , Campanha Afegã de 2001- , Afeganistão , Humanos , Guerra do Iraque 2003-2011 , Prevalência , Estados Unidos/epidemiologia
16.
Otolaryngol Head Neck Surg ; 163(6): 1270-1273, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32746765

RESUMO

Airway epithelia express intrinsic antimicrobial and nutrient-sequestering factors, which contribute to the host defense of the respiratory tract. Hepcidin is an endogenous peptide hormone that serves as a key regulator of iron metabolism, and ferroportin and ZIP8 are iron transporters. All exhibit innate antimicrobial activity. The purpose of this pilot study is to determine if molecules involved in iron regulation are expressed within sinus epithelia and to compare levels of expression between patients with and without chronic rhinosinusitis (CRS). Sinus mucosa was obtained from patients with (n = 19) and without (n = 14) CRS. Real-time polymerase chain reaction following RNA extraction was used to quantify expression of hepcidin, ferroportin, and ZIP8 mRNA. Hepcidin, ferroportin, and ZIP8 were all detected in the sinus epithelia of patients with and without CRS. However, only ZIP8 was significantly changed in CRS, with a 2.5-fold mean increase in mRNA expression relative to controls (P = .005). These findings suggest that ZIP8 may play a role in the innate epithelial defense of the paranasal sinuses.


Assuntos
Proteínas de Transporte de Cátions/metabolismo , Hepcidinas/metabolismo , Rinite/metabolismo , Sinusite/metabolismo , Adulto , Estudos de Casos e Controles , Doença Crônica , Feminino , Humanos , Masculino , Pólipos Nasais/metabolismo , Projetos Piloto
17.
Int Forum Allergy Rhinol ; 10(4): 533-538, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32104956

RESUMO

BACKGROUND: Inverted papilloma (IP) is a benign epithelial tumor of the sinonasal cavity that is locally aggressive and has a propensity for recurrence. Tumors involving the anterior maxillary sinus can be challenging to reach endoscopically, and have historically been approached through a Caldwell-Luc or canine fossa trephination. We present a case series of 22 patients with maxillary IPs originating from the anterior wall, which were successfully resected using a modified endoscopic Denker (MED) procedure. This technique enables access to the entire maxillary sinus without the need for a separate transseptal or sublabial incision. METHODS: A retrospective chart review was performed on patients who underwent the MED approach for management of maxillary IPs involving the anterior wall from 2012 to 2018. The demographic data, clinical presentation, radiographic findings, pathology, and surgical outcomes were reviewed. RESULTS: Twenty-two patients were identified, including 13 males and 9 females. Eighteen of the 22 patients had prior surgery and all had Krouse stage 3 disease. After a mean follow-up of 24 (range, 4-63) months, only 1 patient (4.5%) developed a recurrence, which was treated successfully with endoscopic resection. Complications included 1 patient with preoperative epiphora who required dacryocystorhinostomy, epistaxis in another, and 1 patient with transient upper lip numbness. No patients developed alar notching or pyriform aperture stenosis. CONCLUSION: The MED technique is highly effective for surgical resection of primary and recurrent maxillary IPs involving the anterior wall, providing complete access to the entire maxillary sinus. In many cases, the MED can obviate the need for an adjunctive sublabial or transseptal incision, while also providing excellent exposure for postoperative surveillance.


Assuntos
Neoplasias do Seio Maxilar , Papiloma Invertido , Neoplasias dos Seios Paranasais , Endoscopia , Feminino , Humanos , Masculino , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Neoplasias do Seio Maxilar/diagnóstico por imagem , Neoplasias do Seio Maxilar/cirurgia , Recidiva Local de Neoplasia/cirurgia , Papiloma Invertido/cirurgia , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/cirurgia , Estudos Retrospectivos
19.
Int Forum Allergy Rhinol ; 10(1): 110-113, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31589814

RESUMO

BACKGROUND: Unplanned readmissions within 30 days of discharge is a quality measure introduced by the Centers for Medicare Services. This measure has been used to rate hospital quality and also to penalize hospitals for excess readmissions. It has been hypothesized that shorter hospital stays and fewer readmissions are associated with endoscopic skull base procedures. In this study we analyze endoscopic skull base procedures performed at our institution over a 10-year period to identify rates and factors associated with readmissions after endoscopic skull base surgery. METHODS: A retrospective chart review was performed at a tertiary care academic medical center identifying patients who underwent endoscopic skull base surgery over the past 10 years. Data on patient demographics and tumor variables, as well as patient variables such as body mass index (BMI), revision surgery, history of skull base radiation, medical comorbidities, intraoperative cerebrospinal fluid (CSF) leaks, and postoperative CSF leaks, were recorded. RESULTS: Eight hundred thirty-three patients were included in our study. Sixty-one patients (7.3%) were readmitted a total of 66 times within 30 days. The most common reasons were as follows: hyponatremia (n = 18); CSF leak (n = 17); epistaxis (n = 3); diabetes insipidus (n = 3); rhinorrhea (n = 3); as well as other reasons. Statistical analysis revealed that the presence of intraoperative CSF leak was the only statistically significant variable associated with increased rate of readmissions within 30 days of discharge (p < 0.001). CONCLUSION: Presence of intraoperative CSF leak was the only statistically significant variable associated with an increased risk for readmission after surgery. Other tumor and patient variables were not associated with an increased risk of readmission within 30 days.


Assuntos
Endoscopia/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Base do Crânio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Endoscopia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Base do Crânio/patologia , Neoplasias da Base do Crânio/cirurgia , Centros de Atenção Terciária , Adulto Jovem
20.
Laryngoscope ; 130(1): 2-11, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30835855

RESUMO

OBJECTIVE: To characterize treatment delays in sinonasal cancer managed with surgery and adjuvant radiation and determine the associated impact on survival. STUDY DESIGN: Retrospective cohort study. METHODS: We identified adults in the National Cancer Database treated for sinonasal squamous cell carcinoma with definitive surgery followed by adjuvant radiation from 2004 to 2014. We then examined intervals of diagnosis to surgery (DTS), surgery to radiation (SRT), and radiation duration (RTD). Next, we performed recursive partitioning analysis (RPA) to identify thresholds for these treatment intervals that estimated the greatest differences in survival. We determined the association of treatment delay with overall survival using Cox proportional hazards regression. RESULTS: Among 2,267 patients included, median durations of DTS, SRT, and RTD were 32, 49, and 47 days, respectively. Predictors of treatment delay included care transitions, black race, and Medicare insurance. We identified thresholds of 26, 64, and 51 days for DTS, SRT, and RTD, respectively, as estimating the largest survival differences. Delays in SRT (hazard ratio [HR] 1.20; 95% confidence interval [CI], 1.03-1.40), and RTD (HR, 1.27; 95% CI, 1.10-1.46) beyond these thresholds independently predicted mortality. Delay in DTS beyond the RPA-derived threshold was not significantly associated with mortality after adjusting for other covariates. CONCLUSION: Delays in SRT and RTD intervals are associated with decreased overall survival. Median durations may serve as national benchmarks. Treatment delays could be considered quality indicators for sinonasal cancer treated with surgery and adjuvant radiation. LEVEL OF EVIDENCE: NA Laryngoscope, 130:2-11, 2020.


Assuntos
Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/cirurgia , Neoplasias dos Seios Paranasais/mortalidade , Neoplasias dos Seios Paranasais/cirurgia , Tempo para o Tratamento , Idoso , Carcinoma de Células Escamosas/radioterapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias dos Seios Paranasais/radioterapia , Radioterapia Adjuvante , Estudos Retrospectivos , Taxa de Sobrevida , Estados Unidos
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