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1.
Medicine (Baltimore) ; 98(48): e18120, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770240

RESUMO

The aim of this study was to identify the factors related to occurrence of epiphora or requirement of dacryocystorhinostomy (DCR) in patients with midfacial trauma.We performed a retrospective analysis of the medical records of 1038 patients with midfacial trauma from January 2005 to December 2015. Fifty-one patients (55 cases) diagnosed with nasolacrimal duct (NLD) fracture using facial bone computed tomography were enrolled. Correlation analysis was performed of patient- and injury-related factors, including age, sex, facial trauma etiology, accompanying injury, type and level of the NLD fracture, and time from injury to initial surgery, with the occurrence of epiphora and requirement for DCR.Epiphora occurred in 14.5% and DCR was performed in 5.5% of the patients with NLD fracture. The correlation analysis revealed no significant relationship among the factors with the occurrence of epiphora and requirement for DCR.In patients with midfacial trauma and NLD fracture, epiphora occurred in 14.5% and endoscopic DCR was performed due to persistent epiphora in 5.5% and its result was all successful.


Assuntos
Dacriocistorinostomia/estatística & dados numéricos , Endoscopia/estatística & dados numéricos , Traumatismos Faciais/cirurgia , Doenças do Aparelho Lacrimal/epidemiologia , Ducto Nasolacrimal/lesões , Adolescente , Adulto , Idoso , Criança , Endoscopia/métodos , Traumatismos Faciais/complicações , Feminino , Humanos , Doenças do Aparelho Lacrimal/etiologia , Doenças do Aparelho Lacrimal/cirurgia , Masculino , Pessoa de Meia-Idade , Ducto Nasolacrimal/cirurgia , Estudos Retrospectivos , Adulto Jovem
2.
Am Surg ; 85(11): 1262-1264, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775968

RESUMO

Subcutaneous endoscopically assisted ligation (SEAL) technique is an effective and minimally invasive approach for indirect inguinal hernia repair in children. Not all patients are candidates for SEAL because of technical limitations. We hypothesized that preoperatively assessed patient-level factors may predict technical feasibility of SEAL repair. We performed a retrospective review of all patients who underwent indirect inguinal hernia repair between June 2012 and December 2014. All patients younger than two years and any patient older than two years who had a concomitant umbilical hernia were considered candidates for diagnostic laparoscopy with SEAL repair. We compared patients who had SEAL repair with those who had diagnostic laparoscopy with conversion to open repair. Univariate statistics was performed using the chi-squared and Student's t test. One hundred forty-one patients underwent diagnostic laparoscopy with intent to perform a SEAL repair. Seventeen patients were lost to follow-up. Of the remaining 124 patients, 66 had SEAL repairs, 35 had open repairs, and 23 had a SEAL repair with contralateral open repair. Patient age, BMI, gender, history of prematurity, and history of incarcerated hernia were similar between the SEAL and open groups. Sixty-two per cent of hernias were able to be repaired with SEAL technique. Hernia recurrence was seen in 3 of 123 total SEAL repairs and in 1 of 74 open repairs. The recurrence rate for SEAL repairs (2.4%) was not significantly different from the recurrence rate for open repairs (1.4%). No preoperative patient-level factors predicted technical inability to perform a successful SEAL repair. In this series, the recurrence risk of SEAL compared with open repair was low and not statistically significant. For practitioners with minimally invasive experience, SEAL should be considered a safe and successful option for inguinal hernia repair in pediatric patients undergoing routine diagnostic laparoscopy.


Assuntos
Endoscopia/métodos , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Canal Inguinal/cirurgia , Seleção de Pacientes , Índice de Massa Corporal , Pré-Escolar , Conversão para Cirurgia Aberta/estatística & dados numéricos , Endoscopia/estatística & dados numéricos , Feminino , Hérnia Inguinal/diagnóstico por imagem , Herniorrafia/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido Prematuro , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Ligadura/métodos , Masculino , Estudos Retrospectivos , Fatores Sexuais
3.
Am Surg ; 85(9): 1028-1032, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638519

RESUMO

Hospitalizations for peptic ulcer disease (PUD) have decreased since the advent of specific medical therapy in the 1980s. The authors' clinical experience at a tertiary center, however, has been that procedures to treat PUD complications have not declined. This study tested the hypothesis that despite decreases in PUD hospitalizations, the volume of procedures for PUD complications has remained consistent. The study population included all inpatient encounters in the state of Maryland from 2009 to 2014 with a primary ICD-9 diagnosis code for PUD. Data on annual patient volume, demographics, anatomic location, procedures, complications, and outcomes were collected, and PUD prevalence rates were calculated. The study population consisted of the state's entire population, not a sample; statistical analysis was not applied. Hospitalizations for PUD declined from 2,502 in 2009 to 2,101 in 2014, whereas the percentage of hospitalizations with procedures increased from 27.1 to 31.5 per cent. Endoscopy was performed in 19.8 per cent of hospitalizations, operation in 9.4 per cent, and angiography in 1.3 per cent. Of 13,974 inpatient encounters, 30 per cent had at least one inhospital complication. Overall inpatient mortality was 2.2 per cent. PUD hospitalizations are declining in Maryland, mirroring national trends. A subset of patients continue to need urgent procedures for PUD complications, including nearly 10 per cent needing operation. Inpatient mortality among patients admitted for PUD was 2.2 per cent, congruent with other studies. Despite the efficacy of modern medical therapy, these data underscore the importance of teaching surgical residents the cognitive and operative skills necessary to manage PUD complications.


Assuntos
Hospitalização/estatística & dados numéricos , Úlcera Péptica/complicações , Úlcera Péptica/cirurgia , Angiografia/efeitos adversos , Angiografia/estatística & dados numéricos , Endoscopia/efeitos adversos , Endoscopia/estatística & dados numéricos , Humanos , Maryland/epidemiologia , Úlcera Péptica/diagnóstico por imagem , Úlcera Péptica/mortalidade , Complicações Pós-Operatórias/epidemiologia
4.
Turk J Med Sci ; 49(4): 1109-1116, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31385485

RESUMO

Background/aim: Giant ventral incisional hernias (GVIHs) are hard to manage for surgeons. This problem was resolved in 1990 with the components separation technique (CST). We aimed to compare endoscopic and conventional CST for GVIHs and find a new anthropometric calculation. Materials and methods: In this prospective nonrandomized clinical trial, 21 patients were treated with endoscopic or conventional CST between 2012 and 2016. Eight patients (38.1%) were operated endoscopically and 13 (61.9%) conventionally on the basis of preoperative tomography results, hernia surface area (HSA), number of recent abdominal operations, comorbidities, and the presence or history of ostomy. Groups in which prosthetic material was applied were also compared with groups in which it was not Results: There was no statistically significant difference between endoscopic and conventional CST groups in terms of complications. A weakly statistically significant difference (P = 0.069) was found between the components separation index (CSI) of mesh-applied and not-applied patients. HSA/body surface area (BSA) was statistically significantly different between endoscopic and conventional CST groups. Conclusion: According to our results, HSA/BSA and CSI are statistically successful for preoperative prediction of mesh placement. Furthermore, HSA/BSA preoperatively successfully predicts whether conventional or endoscopic CST should be used in patients with GVIH


Assuntos
Endoscopia/métodos , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscopia/efeitos adversos , Endoscopia/estatística & dados numéricos , Feminino , Herniorrafia/efeitos adversos , Herniorrafia/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Adulto Jovem
5.
Acta otorrinolaringol. esp ; 70(4): 185-191, jul.-ago. 2019. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-185394

RESUMO

Introducción y objetivos: El objetivo fue determinar los resultados del tratamiento de las epistaxis graves y/o refractarias que requirieron ingreso hospitalario. Además se compararon los resultados del tratamiento mediante ligadura arterial o embolización. Material y método: Se incluyeron de forma prospectiva 63 pacientes con epistaxis grave y/o refractaria que requirieron ingreso hospitalario entre agosto de 2014 y diciembre de 2016. Resultados: En 11 pacientes (17%) se realizó embolización, 5 (8%) fueron intervenidos mediante endoscopia y en los 47 restantes (75%) se realizó tratamiento conservador. La edad media de los pacientes en los que las medidas conservadoras fueron suficientes fue de 72 años, mientras que la edad de aquellos tratados con embolización fue de 71 años y de los que fueron intervenidos quirúrgicamente fue de 53 años. En los pacientes sometidos a tratamiento conservador o a cirugía la estancia media fue de 6 días, frente a 9 días en aquellos en los que se realizó embolización. Un paciente sufrió un ictus hemisférico tras la embolización. No se observaron complicaciones posquirúrgicas. Conclusiones: La mayoría de los pacientes con epistaxis graves y/o refractarias se resuelven mediante taponamiento convencional. El tratamiento mediante ligadura arterial está asociado a una disminución de la estancia hospitalaria, sin observarse complicaciones graves. Es aconsejable disponer de todas las opciones terapéuticas posibles para lo cual la presencia de radiólogos intervencionistas y cirujanos experimentados es fundamental para evitar complicaciones y decidir el tratamiento a realizar de forma individual en cada paciente


Objective: The objective was to determine the results of the treatment of severe and/or refractory epistaxis requiring hospital admission. In addition, the results of arterial ligation versus embolization were compared. Material and method: Sixty-three patients with severe and/or refractory epistaxis requiring hospital admission between August 2014 and December 2016 were included prospectively. Results: Eleven patients (17%) underwent embolization, 5 (8%) endoscopy ligation and the remaining 47 (75%) underwent conservative treatment with tamponade. The mean age of the patients in which conservative measures were sufficient was 72 years, while the age of those treated with embolization was 71 years and of those who underwent surgery was 53 years. For the patients who underwent conservative treatment or surgery, the average stay was 6 days, compared to 9 days for those who underwent embolization. One patient suffered a hemispheric stroke after embolization. No post-surgical complications were observed. Conclusions: Most cases of severe and/or refractory epistaxis are resolved by conventional tamponade. Endoscopy ligation is associated with a decrease in hospital stay, without serious complications. It is advisable to have all the possible therapeutic options available, for which the presence of interventional radiologists and experienced surgeons is essential to avoid complications and decide the treatment to be performed individually for each patient


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Epistaxe/terapia , Técnicas Hemostáticas , Comorbidade , Tratamento Conservador , Embolização Terapêutica/efeitos adversos , Endoscopia/métodos , Endoscopia/estatística & dados numéricos , Epistaxe/cirurgia , Técnicas Hemostáticas/estatística & dados numéricos , Hospitalização , Tempo de Internação/estatística & dados numéricos , Ligadura/estatística & dados numéricos , Utilização de Procedimentos e Técnicas , Estudos Prospectivos , Recidiva , Acidente Vascular Cerebral/etiologia , Tampões Cirúrgicos , Resultado do Tratamento
6.
Otolaryngol Head Neck Surg ; 161(4): 683-687, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31184274

RESUMO

OBJECTIVE: Balloon sinuplasty (BS) is a surgical management option in the treatment of chronic rhinosinusitis. The purpose of this study was to examine BS utilization among children with a national database. STUDY DESIGN: Retrospective review. SETTING: National pediatric database. SUBJECTS AND METHODS: All cases of children aged ≤18 years who underwent BS or traditional endoscopic sinus surgery (ESS) 5 years before and after the introduction of BS billing codes were studied with the Pediatric Health Information System database. We evaluated overall trends, demographics, performing physicians, readmissions, and cost data. RESULTS: A total of 14,079 patients met inclusion criteria: 13,555 underwent traditional ESS and 524 had a BS procedure. There was no significant increase in BS rates between 2011 and 2016. BS was more commonly performed among younger children than ESS (median age [interquartile range], 6 years [4-10] vs 9 years [6-13]; P < .001). There were 23 (4.4%) readmissions within 30 days in the balloon cohort versus 474 (3.5%) in the ESS cohort. The median cost of balloon maxillary antrostomy (US $6560 [$5420-$8250]) was higher than that of traditional maxillary antrostomy (US $5630 [$4130-$7700], P < .001). Physicians who performed BS had a larger volume of ESS procedures when compared with those who did not perform BS. CONCLUSION: Rates of BS performance in the pediatric population have not increased over time. Results showed no difference in readmission rates between BS and ESS. BS was associated with higher costs as compared with ESS. The role of BS in the pediatric chronic rhinosinusitis population remains unclear.


Assuntos
Cateterismo/estatística & dados numéricos , Endoscopia/estatística & dados numéricos , Cirurgia Endoscópica por Orifício Natural/estatística & dados numéricos , Rinite/cirurgia , Sinusite/cirurgia , Adolescente , Cateterismo/métodos , Criança , Pré-Escolar , Doença Crônica , Bases de Dados Factuais , Dilatação/métodos , Dilatação/estatística & dados numéricos , Endoscopia/métodos , Feminino , Humanos , Masculino , Seios Paranasais/cirurgia , Estudos Retrospectivos , Estados Unidos
7.
J Prev Med Public Health ; 52(3): 179-187, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31163953

RESUMO

OBJECTIVES: In the USA, certain races and ethnicities have a disproportionately higher gastric cancer burden. Selective screening might allow for earlier detection and curative resection. Among a USA-based multiracial and ethnic cohort diagnosed with non-cardia gastric cancer (NCGC), we aimed to identify factors associated with curable stage disease at diagnosis. METHODS: We retrospectively identified endoscopically diagnosed and histologically confirmed cases of NCGC at Mount Sinai Hospital in New York City. Demographic, clinical, endoscopic and histologic factors, as well as grade/stage of NCGC at diagnosis were documented. The primary outcome was the frequency of curable-stage NCGC (stage 0-1a) at diagnosis in patients with versus without an endoscopy negative for malignancy prior to their index exam diagnosing NCGC. Additional factors associated with curable-stage disease at diagnosis were determined. RESULTS: A total of 103 racially and ethnically diverse patients were included. Nearly 38% of NCGC were stage 0-Ia, 34% stage Ib-III, and 20.3% stage IV at diagnosis. A significantly higher frequency of NCGC was diagnosed in curable stages among patients who had undergone an endoscopy that was negative for malignancy prior to their index endoscopy that diagnosed NCGC, compared to patients without a negative endoscopy prior to their index exam (69.6% vs. 28.6%, p=0.003). A prior negative endoscopy was associated with 94.0% higher likelihood of diagnosing curable-stage NCGC (p=0.003). No other factors analyzed were associated with curable-stage NCGC at diagnosis. CONCLUSIONS: Endoscopic screening and surveillance in select high-risk populations might increase diagnoses of curable-stage NCGC. These findings warrant confirmation in larger, prospective studies.


Assuntos
Endoscopia/normas , Neoplasias Gástricas/diagnóstico , População Urbana/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Endoscopia/métodos , Endoscopia/estatística & dados numéricos , Feminino , Infecções por Helicobacter/epidemiologia , Helicobacter pylori/patogenicidade , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Estudos Retrospectivos , Neoplasias Gástricas/epidemiologia
8.
Laryngoscope ; 129(9): 1976-1983, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31012972

RESUMO

OBJECTIVES: Odontogenic sinusitis (ODS) is more common than historically reported, and management recommendations are limited in the literature. Although ODS case series have shown successful outcomes with dental treatment and endoscopic sinus surgery (ESS), no studies have considered the optimal timing of these treatments. The purpose of this study was to analyze times to ODS resolution after primary dental treatment and ESS based on symptom, 22-item sinonasal outcome test (SNOT-22), and endoscopic outcomes. STUDY DESIGN: Prospective cohort study. METHODS: Thirty-seven symptomatic ODS patients who failed medical management were offered primary dental treatment or ESS. Eleven patients selected primary dental treatment, and 26 patients selected ESS. The following variables were collected prospectively at every office visit before and after dental treatment or ESS: SNOT-22, presence or absence of cardinal sinusitis symptoms, and presence or absence of middle meatal endoscopy findings (edema, polyps, purulence). Times to resolution of these clinical variables were analyzed with t test, chi-square test, Fisher exact test, McNemar test, and Kaplan-Meier survival analysis. RESULTS: Patients in the dental treatment and ESS groups showed no significant differences in preoperative sinusitis disease burdens based on symptoms, SNOT-22, endoscopy, and computed tomography. The ESS group experienced faster and more significant improvement in nearly all symptom, SNOT-22, and endoscopic outcomes. CONCLUSIONS: For symptomatic ODS, primary ESS resulted in faster resolution of SNOT-22, sinusitis symptoms, and endoscopic findings in ODS patients compared with primary dental treatment. ESS can be considered first-line therapy for symptomatic ODS, followed by dental treatment when necessary. LEVEL OF EVIDENCE: 2b Laryngoscope, 129:1976-1983, 2019.


Assuntos
Endoscopia/estatística & dados numéricos , Sinusite Maxilar/cirurgia , Procedimentos Cirúrgicos Bucais/estatística & dados numéricos , Seios Paranasais/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Doença Crônica , Terapia Combinada , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
9.
World J Surg ; 43(8): 1964-1971, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30941454

RESUMO

BACKGROUND: Practice variations exist amongst parathyroid surgeons depending on their expertise and resources. Our study aims to elucidate the choice of surgical techniques and adjuncts used in parathyroid surgery by surgeons in the Asia-Pacific region. METHODS: A 25-question online survey was sent to members of five endocrine surgery associations. Questions covered training background, practice environment and preferred techniques in parathyroid surgery. Respondents were divided into three regions: Australia/New Zealand, South/South East Asia and East Asia, and responses were analysed according to region, specialty, case volume and years in practice. RESULTS: One hundred ninety-six surgeons returned the questionnaire. Most surgeons (98%) routinely perform preoperative imaging, with 75% preferring dual imaging with 99mTcsestamibi and ultrasound. Ten per cent of surgeons use parathyroid 4DCT as first-line imaging, more commonly in East Asia (p = 0.038). Minimally invasive parathyroidectomy is the favoured technique of choice (97%). Most surgeons reporting robotic or endoscopic approaches are from East Asia. Rapid intraoperative parathyroid hormone is accessible to just under half of the surgeons but less available in Australian/New Zealand (p < 0.001). The use of intraoperative neuromonitoring is not commonly used, even less so amongst Asian surgeons (p = 0.048) and surgeons with low case load (p = 0.013). CONCLUSION: Dual localisation techniques are the preferred choice of investigations in preparation for parathyroid surgery, with minimally invasive surgery without neuromonitoring the preferred approach. Use of adjuncts is sporadic and limited to certain centres.


Assuntos
Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Paratireoidectomia/métodos , Padrões de Prática Médica/estatística & dados numéricos , Ásia Sudeste , Austrália , Endoscopia/estatística & dados numéricos , Extremo Oriente , Tomografia Computadorizada Quadridimensional/estatística & dados numéricos , Humanos , Monitorização Neurofisiológica Intraoperatória/estatística & dados numéricos , Nova Zelândia , Hormônio Paratireóideo/sangue , Período Pré-Operatório , Cintilografia/estatística & dados numéricos , Compostos Radiofarmacêuticos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Inquéritos e Questionários , Tecnécio Tc 99m Sestamibi , Ultrassonografia/estatística & dados numéricos
10.
Laryngoscope ; 129(10): 2224-2229, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30883780

RESUMO

OBJECTIVES/HYPOTHESIS: Balloon sinuplasty has become an increasingly popular option for patients undergoing surgical treatment of sinusitis. This study analyzes utilization and growth of these procedures across a large cohort of patients over a 5-year period. STUDY DESIGN: Retrospective data review. METHODS: This was a retrospective review of Medicare utilization and billing data. Utilization and payment values were obtained from Medicare claims data using Centers for Medicare and Medicaid Services datasets. All Medicare claims were analyzed from 2012 to 2016. Data were extracted for balloon sinuplasty and endoscopic sinus surgery claims. Procedure location, total submitted claims, charges, and payments were compared. RESULTS: From 2012 to 2016, the number of balloon procedures increased from 5,603 to 25,640. Traditional endoscopic sinus surgery procedures increased from 15,509 to 18,164. Aggregate Medicare payments to otolaryngologists for endoscopic sinus surgery have remained relatively stable, whereas there has been a 450% increase in total payments to providers of balloon sinuplasty. In 2016, total payments to providers of balloon procedures ($40.5 million) were substantially higher than payments to providers of non-balloon-based endoscopic sinus surgery ($4.7 million). The number of providers performing balloon procedures has increased 277% versus 17% for traditional sinus surgery. CONCLUSIONS: There has been a rapid expansion in the number of sinus procedures in the Medicare population from 2012 to 2016. Office-based balloon procedures account for the overwhelming majority of the increases in procedures and payments. Per procedure and aggregate payments are now higher for sinuplasty procedures than for traditional sinus surgery. LEVEL OF EVIDENCE: NA Laryngoscope, 129:2224-2229, 2019.


Assuntos
Endoscopia/estatística & dados numéricos , Reembolso de Seguro de Saúde/estatística & dados numéricos , Procedimentos Cirúrgicos Nasais/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Sinusite/cirurgia , Idoso , Endoscopia/instrumentação , Endoscopia/métodos , Feminino , Humanos , Masculino , Medicare , Procedimentos Cirúrgicos Nasais/instrumentação , Procedimentos Cirúrgicos Nasais/métodos , Seios Paranasais/cirurgia , Estudos Retrospectivos , Estados Unidos
11.
Ann Otol Rhinol Laryngol ; 128(5): 401-405, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30739476

RESUMO

OBJECTIVE: Multidisciplinary vascular anomaly clinics (VACs) offer important value to pediatric patients with complex vascular anomalies whose care overlaps specialties. These clinics are labor intensive and costly to operate since providers see fewer patients compared to their individual specialty clinic. Our North American tertiary care institution's VAC specialists include a pediatric otolaryngologist, pediatric surgeon, pediatric plastic surgeon, pediatric dermatologist, and interventional radiologist. To assess financial feasibility, we conducted a cost analysis of our VACs comprised of 2 half-day multidisciplinary physician attended clinics (5 specialists at our main campus and 2 specialists at a satellite clinic) and a half-day nurse practitioner clinic. METHOD: Assessment of net revenue based on net collections for clinic, professional, operative, hospital setting, and facility charges generated during 12 consecutive monthly VACs beginning July 1, 2015. Expense calculations included provider and staff salaries, benefits, supply costs, and clinic leasing costs. RESULTS: There were 469 clinic visits, of which 202 were new patient evaluations. Sixty-eight patients underwent 93 procedures under general anesthesia, including procedures performed by our interventional radiologist, most commonly sclerotherapy or embolization (n = 37), surgical interventions including endoscopy (n = 36), or laser procedures (n = 20). Three patients were admitted. Fifty-seven patients received a new diagnosis different from that for which they were referred. Gross revenue was $1 810 525, and net revenue was 42.5%, or $783 152. Expenses totaled $453 415 for a net positive revenue of $329 737. CONCLUSION: When including direct downstream revenue, particularly from operative procedures, our VAC program operates on a net positive margin, making the program financially feasible.


Assuntos
Instituições de Assistência Ambulatorial/economia , Malformações Vasculares/terapia , Anestesia Geral/estatística & dados numéricos , Custos e Análise de Custo , Embolização Terapêutica/economia , Embolização Terapêutica/estatística & dados numéricos , Endoscopia/economia , Endoscopia/estatística & dados numéricos , Estudos de Viabilidade , Pessoal de Saúde/economia , Humanos , Terapia a Laser/economia , Terapia a Laser/estatística & dados numéricos , América do Norte , Admissão do Paciente/economia , Admissão do Paciente/estatística & dados numéricos , Pediatria , Mecanismo de Reembolso , Estudos Retrospectivos , Salários e Benefícios/economia , Escleroterapia/economia , Escleroterapia/estatística & dados numéricos
12.
JAMA Otolaryngol Head Neck Surg ; 145(3): 258-263, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30703193

RESUMO

Importance: Nasal endoscopy is the most highly reimbursed routine clinical procedure in otolaryngology by Medicare. To our knowledge, the economic and demographic characteristics of nasal endoscopy have not been characterized at a population level. Objective: To quantify trends in use of nasal endoscopy among Medicare recipients at a national and state level. Design, Setting, and Participants: Cross-sectional study of procedure and beneficiary data from January 1, 2000, to December 31, 2016, and available health care provider data from 2015 obtained from the Centers for Medicare & Medicaid Services for all diagnostic nasal endoscopies categorized as Current Procedural Terminology code 31231. Exposures: Diagnostic nasal endoscopy. Main Outcomes and Measures: Nasal endoscopies were analyzed by state, medical or surgical specialty, mean reimbursement, health care provider density, and type of health care practitioner performing the procedure. Results: The Centers for Medicare & Medicaid Services reimbursed $86.3 million for 559 547 nasal endoscopies in 2016. The total number of nasal endoscopies increased 313%, from 135 494 in 2000 to 559 547 in 2016 (9.3% average annual rate of increase). The mean reimbursement rate per nasal endoscopy varied by state, from $114.25 in Puerto Rico to $189.53 in New York. The percentage of Medicare beneficiaries receiving nasal endoscopy per state ranged from 0.1% in Alaska to 1.7% in New York. Almost all nasal endoscopies were performed by physicians (97.3%), with otolaryngologists (97.2%) being the most common specialty. Reimbursement rates (r = 0.60) and density of health care providers (r = -0.56) were correlated with higher utilization in a state's Medicare population. Conclusions and Relevance: Utilization of nasal endoscopy by otolaryngologists in the Medicare population appears to have increased substantially over the past 2 decades. Practice patterns and reimbursement appeared to vary across the United States.


Assuntos
Endoscopia/estatística & dados numéricos , Medicare , Procedimentos Cirúrgicos Nasais/estatística & dados numéricos , Otolaringologia , Idoso , Humanos , Padrões de Prática Médica , Utilização de Procedimentos e Técnicas , Estados Unidos
13.
Asian J Endosc Surg ; 12(1): 7-18, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30681279

RESUMO

In Japan, the first endoscopic surgery, a laparoscopic cholecystectomy, was performed in 1990. Since then, the operative procedure has been standardized, and the safety and usefulness of endoscopic surgery have been evaluated. In accordance with the social acceptance of endoscopic surgery as a less-invasive surgery, the number of endoscopic procedures has been increasing in all surgical domains. The Japan Society for Endoscopic Surgery (JSES) has played an important role in the development of endoscopic surgery in Japan. For example, JSES established a technical skills certification system for surgeons to train instructors how to teach safe endoscopic surgery, and the organization performs a national survey every 2 years. In 2015, a total of 211 953 patients underwent endoscopic surgery in all surgical domains, including abdominal, thoracic, mammary and thyroid gland, cardiovascular, obstetrics and gynecology, urologic, orthopedic, and plastic surgery. The course of laparoscopic surgery's development and its current status are reported here based on the results of the most recent questionnaire survey conducted by JSES.


Assuntos
Endoscopia/estatística & dados numéricos , Complicações Intraoperatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Endoscopia/efeitos adversos , Humanos , Japão , Seleção de Pacientes , Utilização de Procedimentos e Técnicas , Inquéritos e Questionários
14.
J Craniofac Surg ; 30(2): e160-e163, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30664556

RESUMO

BACKGROUND: The aim of the study was to compare the effectiveness of endoscopic endonasal reduction using a bioresorbable panel and silastic sheet packed with Merocel for blowout fractures of the medial orbital wall. DESIGN: Retrospective study. METHODS: The study group consisted of 147 patients who underwent endoscopic endonasal reduction of a blowout fracture of the medial orbital wall between January 2005 and December 2016. Fifty-seven fractures were repaired using a splint formed by a silastic sheet and Merocel (splint group), whereas 90 fractures were repaired using a bioresorbable panel for interposition (interposition group). Postoperative complications and surgical outcomes of the 2 groups were compared. RESULTS: Preoperative diplopia in both groups (n = 30) was resolved except 1 in interposition group after the reduction. Enophthalmos was resolved in 10 cases in the splint group and in 6 cases in the interposition group. In postoperative CT scans, 20 of the 57 cases in the splint group exhibited under- or overcorrection, compared with 9 of the 90 cases in the interposition group (P < 0.05). There were no sinus infections or implant-related side effects in the interposition group except for implant extrusion in 4 cases, whereas 7 cases developed sinusitis in the splint group (P < 0.05). CONCLUSIONS: Endonasal endoscopic reduction using a bioresorbable panel may be considered as a surgical alternative for the treatment of medial orbital blowout fractures.


Assuntos
Endoscopia , Fraturas Orbitárias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Implantes Absorvíveis , Dimetilpolisiloxanos/uso terapêutico , Endoscopia/efeitos adversos , Endoscopia/instrumentação , Endoscopia/métodos , Endoscopia/estatística & dados numéricos , Humanos , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Estudos Retrospectivos
15.
Laryngoscope ; 129(2): 429-434, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30229933

RESUMO

OBJECTIVES: The purpose of this study was to introduce a new narrow band imaging (NBI) endoscopic classification for the diagnosis of vocal cord leukoplakia. STUDY DESIGN: Case series. METHODS: From January 2010 to February 2018, a total of 120 cases of vocal cord leukoplakia were enrolled in this study. The NBI endoscopic system was used to examine the vocal cords. Each lesion was observed by NBI endoscopy and evaluated according to the detailed morphologic findings of intraepithelial papillary capillary loop (IPCL). The superficial IPCL patterns were classified into six types (types I-VI). The differential diagnosis abilities of NBI classification for benign and malignant leukoplakia were investigated. RESULTS: Out of the 120 cases of vocal cord leukoplakia, 81% (97 of 120) related to benign lesions (including inflammation, epithelial proliferation, hyperkeratosis, dyskeratosis, mild dysplasia, and moderate dysplasia); the remaining 19% (23 of 120) consisted of malignant lesions (including severe dysplasia, carcinoma in situ, and invasive carcinoma). The accuracy of differential diagnosis for vocal cord leukoplakia using NBI endoscopy was up to 90.8% (109 of 120), significantly higher than that of white light imaging (70.0%, 84 of 120) (χ2 = 16.536, P = 0.000). The sensitivity, specificity, and positive and negative predictive values of the diagnosis for malignant vocal cord leukoplakia under the NBI endoscope were 82.6%, 92.8%, 73.1%, and 95.7%, respectively. There is relatively good consistency between the NBI endoscopic diagnosis and pathological diagnosis (kappa = 0.718, P = 0.000). CONCLUSION: The new NBI endoscopic classification of vocal cord leukoplakia can improve the accuracy of distinguishing benign and malignant leukoplakia. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:429-434, 2019.


Assuntos
Endoscopia/estatística & dados numéricos , Doenças da Laringe/diagnóstico por imagem , Leucoplasia/diagnóstico por imagem , Imagem de Banda Estreita/estatística & dados numéricos , Prega Vocal/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Endoscopia/métodos , Feminino , Humanos , Neoplasias Laríngeas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Imagem de Banda Estreita/métodos , Valor Preditivo dos Testes , Sensibilidade e Especificidade
16.
Acta Otorrinolaringol Esp ; 70(4): 185-191, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29784243

RESUMO

OBJECTIVE: The objective was to determine the results of the treatment of severe and/or refractory epistaxis requiring hospital admission. In addition, the results of arterial ligation versus embolization were compared. MATERIAL AND METHOD: Sixty-three patients with severe and/or refractory epistaxis requiring hospital admission between August 2014 and December 2016 were included prospectively. RESULTS: Eleven patients (17%) underwent embolization, 5 (8%) endoscopy ligation and the remaining 47 (75%) underwent conservative treatment with tamponade. The mean age of the patients in which conservative measures were sufficient was 72 years, while the age of those treated with embolization was 71 years and of those who underwent surgery was 53 years. For the patients who underwent conservative treatment or surgery, the average stay was 6 days, compared to 9 days for those who underwent embolization. One patient suffered a hemispheric stroke after embolization. No post-surgical complications were observed. CONCLUSIONS: Most cases of severe and/or refractory epistaxis are resolved by conventional tamponade. Endoscopy ligation is associated with a decrease in hospital stay, without serious complications. It is advisable to have all the possible therapeutic options available, for which the presence of interventional radiologists and experienced surgeons is essential to avoid complications and decide the treatment to be performed individually for each patient.


Assuntos
Epistaxe/terapia , Técnicas Hemostáticas , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Tratamento Conservador , Embolização Terapêutica/efeitos adversos , Endoscopia/métodos , Endoscopia/estatística & dados numéricos , Epistaxe/cirurgia , Feminino , Técnicas Hemostáticas/estatística & dados numéricos , Hospitalização , Humanos , Tempo de Internação/estatística & dados numéricos , Ligadura/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Utilização de Procedimentos e Técnicas , Estudos Prospectivos , Recidiva , Acidente Vascular Cerebral/etiologia , Tampões Cirúrgicos , Resultado do Tratamento , Adulto Jovem
17.
Laryngoscope ; 129(1): 31-36, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30208209

RESUMO

OBJECTIVES/HYPOTHESIS: Minimum clinically important differences (MCIDs) for the 22-item SinoNasal Outcomes Test (SNOT-22) in patients with chronic rhinosinusitis (CRS) electing endoscopic sinus surgery (ESS) are well described. However, similar estimations for the MCID have not been investigated for patients electing continued appropriate medical therapy (CAMT). We sought to determine MCID values for a medically treated CRS cohort and compare them to historical MCIDs associated with ESS. STUDY DESIGN: Prospective observational cohort study. METHODS: One hundred twenty patients with refractory CRS electing CAMT were prospectively enrolled from academic referral clinics into an observational cohort study. Baseline and posttreatment SNOT-22 survey responses were collected. Four distribution-based methods for calculating MCIDs (e.g., half-standard deviation, Cohen's d, standard error of measurement, and minimum detectable change) were used to identify a range of MCID values for SNOT-22 total and domain scores. RESULTS: The average MCID value for SNOT-22 total scores was 8.0, whereas mean MCID values for rhinologic, extranasal rhinologic, ear/facial, psychological, and sleep symptom domain scores were 3.9, 2.5, 3.3, 3.4, and 2.9, respectively, comparable to previously reported values for patients electing ESS. Although change in SNOT-22 total scores following CAMT exceeded the MCID, none of the average SNOT-22 domain score improvements surpassed their respective MCID thresholds. CONCLUSIONS: MCID values for SNOT-22 total and domain scores in patients electing CAMT are similar to previously published MCID values associated with ESS, indicating that MCID values are independent of treatment modality selection. Therefore, despite evidence of statistical significance, CAMT for CRS may not be associated with clinically discernable improvements in average SNOT-22 domain scores. LEVEL OF EVIDENCE: 2c Laryngoscope, 129:31-36, 2019.


Assuntos
Diferença Mínima Clinicamente Importante , Seios Paranasais/cirurgia , Rinite/cirurgia , Índice de Gravidade de Doença , Sinusite/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Endoscopia/métodos , Endoscopia/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Resultado do Tratamento
18.
Hand (N Y) ; 14(2): 209-216, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29117740

RESUMO

BACKGROUND: Medicare reimbursement is known to exhibit geographic variation for inpatient orthopedic procedures. This study determined whether US geographic variations also exist for commonly performed hand surgeries. METHODS: Using the Medicare Provider Utilization and Payment Data (2012-2013) from Centers for Medicare & Medicaid Services, we analyzed regional physician charges/payments for common outpatient hand surgeries. RESULTS: The most commonly performed procedures in the United States were open carpal tunnel release (n = 21 944), trigger finger release (n = 15 345), endoscopic carpal tunnel release (n = 7106), and basal joint arthroplasty/ligament reconstruction and tendon interposition (n = 2408). A range of average Medicare physician reimbursements existed based on geographic region for basal joint arthroplasty ($669-$571), endoscopic carpal tunnel release ($400-$317), open carpal tunnel release ($325-$261), and trigger finger release ($215-$167). The latter three exhibited statistically significant variation across geographic regions with regard to both charges and physician reimbursement. However, the overall percentage physician reimbursement (70%-79%) to charges was similar across all geographic regions. CONCLUSIONS: In conclusion, further research is warranted to determine why regional or geographic variations in physician payments exist in the United States for commonly performed hand surgeries.


Assuntos
Medicare/economia , Procedimentos Ortopédicos/economia , Área de Atuação Profissional , Síndrome do Túnel Carpal/cirurgia , Articulações Carpometacarpais/cirurgia , Endoscopia/economia , Endoscopia/estatística & dados numéricos , Humanos , Procedimentos Ortopédicos/estatística & dados numéricos , Dedo em Gatilho/cirurgia , Estados Unidos
19.
Turk J Gastroenterol ; 30(2): 148-154, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30459134

RESUMO

BACKGROUND/AIMS: In South Korea, the flexible endoscopic evaluation of swallowing (FEES) has been increasingly performed by gastroenterologists. The principal concern was the safety of the FEES performed by gastroenterologists without any involvement of speech-language pathologists. We aimed to characterize the safety and tolerance of gastroenterologist-directed FEES examinations (GDFEES). MATERIALS AND METHODS: We evaluated the GDFEES failures, safety profile (laryngospasm, epistaxis, vasovagal syncope, airway compromise, heart rate, blood pressure, and significant change in cardiovascular function), and discomfort level in patients undergoing GDFEES. These outcomes were also analyzed based on gender, age, and calendar period. RESULTS: A total 303 examinations in 268 adult patients with dysphagia were performed during the study period. The GDFEES failures occurred in 5 patients (1.7%). The causes of failures were poor co-operation and insertion difficulty. There were no instances of laryngospasm or vasovagal syncope or significant cardiovascular changes in any of the examinations. Self-limiting epistaxis occurred in 22 examinations (7.3%). The discomfort ratings were as follows: 128 examinations (43.0%) rated the overall discomfort of the test as none, 150 (50.3%) as mild, 18 (6.0%) as moderate, and 2 (0.7%) as severe discomfort. The discomfort level was significantly different only between the first and second half periods (p <0.001), but it was related to neither gender nor age. CONCLUSION: The GDFEES can be endorsed as an appropriate paradigm for clinical practice based on our study investigating its safety and tolerance.


Assuntos
Transtornos de Deglutição/diagnóstico , Endoscopia/estatística & dados numéricos , Gastroenterologistas/estatística & dados numéricos , Gastroenterologia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Deglutição , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Gastroenterologia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Adulto Jovem
20.
Dysphagia ; 34(2): 192-200, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30456424

RESUMO

One of the major limitations of the fiberoptic endoscopic evaluation of swallowing (FEES) is related to the challenging application of temporal measures. Among them, Whiteout (WO) is due to pharyngeal and tongue base contraction and might be used as an estimation of the pharyngeal phase duration. The aims of this study were to evaluate the inter- and intrarater reliability of WO duration and to appraise the effects of age, sex, volume, and texture of the boluses on this temporal measurement. A total of 30 healthy volunteers were recruited. According to their age, the subjects were grouped into three different age groups. Each of them underwent FEES examination with different textures (liquid, semisolid, and solid) and volumes. FEES examinations were video recorded, processed with the software Daisy Viewer 2.0, which allowed the acquisition of 25 frames per second (s) and analyzed by three different raters in order to collect data on WO duration. A total of 863 swallowing acts were video recorded. Intra- and interrater reliability of WO duration were excellent. Both volume and bolus's texture significantly affected WO duration. In particular, WO duration was significantly shorter for the liquid texture than for the semisolid and solids ones. In addition, male subjects scored significantly higher values of WO duration. Finally, WO duration was significantly higher in seniors. WO duration seems to be a reliable temporal measure during FEES examination. WO duration seems to be affected by several factors such as age, sex, volume, and consistency.


Assuntos
Cinerradiografia/estatística & dados numéricos , Transtornos de Deglutição/diagnóstico por imagem , Endoscopia/estatística & dados numéricos , Tecnologia de Fibra Óptica/estatística & dados numéricos , Fluoroscopia/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Cinerradiografia/métodos , Deglutição , Endoscopia/métodos , Feminino , Tecnologia de Fibra Óptica/métodos , Fluoroscopia/métodos , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Faringe/diagnóstico por imagem , Reprodutibilidade dos Testes , Fatores Sexuais , Língua/diagnóstico por imagem , Adulto Jovem
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