To characterize the national trend for surgical resection of vestibular schwannoma (VS) and to assess changes in demographics, length of stay (LOS), discharge patterns, and hospital charges.
...Population-based inpatient registry analysis.
National Inpatient Sample and SEER database (Surveillance, Epidemiology, and End Results).
Retrospective review of the US National Inpatient Sample and the SEER database from 2001 to 2014 of all patients who underwent resection of VS.
A total of 24,380 VS resections were performed. While the annual incidence of VS remained stable at 1.38 per 100,000, surgical volume declined by 36.1%, from 2807 in 2001 to 1795 in 2014 (
= 0.58). Total hospital charges more than doubled, from $52,475 in 2001 to $115,164 in 2014 ($4478 per year,
= 0.96). While most procedures were performed at large-sized hospitals, this decreased from 89% in 2002 to 75.8% in 2014. Average LOS remained stable at 5.2 days during the study period. The number of discharges to a nursing facility increased from 113 (5.5%) in 2002 to 245 (13.6%) in 2014 (
= .0002).
VS resection has evolved in the United States. While the incidence remained stable, surgical volume decreased by 36%, and hospital charges more than doubled. More cases are being performed at smaller hospitals. Although LOS did not vary significantly, there is an increase in nonroutine discharges. These data may guide future research in resource utilization in neurotology.
Complications due to acute otitis media (AOM), while rare, are associated with significant morbidity and are not well characterized from an epidemiological perspective. We analyze the pattern of ...presentation and emergency department (ED) utilization in patients with AOM and associated complications.
Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 to 2011.
Emergency Department.
Patients who presented with a primary diagnosis of AOM or acute mastoiditis.
Diagnostic.
NEDS was queried for patient encounters with a diagnosis of AOM or acute mastoiditis based on ICD-9 codes. Complications of severe infection, including petrositis, Gradenigo's syndrome, facial paresis, labyrinthitis, meningitis, intracranial abscess, venous sinus thrombosis, and cerebrospinal fluid leak, were assessed. Weighted estimates for demographics, types of complications, socioeconomic status, and trends over time were extracted.
A weighted total of 5,811,127 ED visits were identified. The majority of patients were less than 18 years old (79.9%) with an average age of 10.1 years. Most were discharged (99.4%). There were 15,243 (0.26%) patients who presented with a complication. The most common complications were acute mastoiditis (0.16%), labyrinthitis (0.06%), and facial paresis (0.03%). Compared with patients with uncomplicated AOM, patients with complicated AOM were older (37 vs. 10-yr old), insured by Medicare (18% vs. 2.1%), and more likely to be admitted (43.6% vs. 0.4%) (p < 0.0001, for all comparisons).
ED visits related to AOM or mastoiditis are common and complications are rare. An in-depth analysis on a national level is useful for assessing healthcare utilization trends.
Objectives/Hypothesis
To describe outcomes of a single institution experience with sentinel lymph node biopsy (SLNB) for high‐risk cutaneous squamous cell carcinoma of the head and neck.
Study Design
...Retrospective case series.
Methods
Chart review was performed for patients who presented with clinically node negative cutaneous squamous cell carcinoma of the head and neck between December 2007 and May 2018. Patients who met high‐risk criteria underwent SLNB and excision, with or without adjuvant therapy. Patients who underwent prior neck dissection were excluded. The main outcomes were SLNB result, lymph node spread, recurrence‐free survival, disease‐specific survival, and overall survival.
Results
Eighty‐three patients underwent successful SLNB, and one patient underwent selective neck dissection for intraoperatively identified occult lymph node metastasis. Five patients (6%) had a sentinel node positive for tumor, of whom 4/5 received further treatment (neck dissection, radiation, and/or systemic therapy) with no further recurrence at the time of last follow‐up. SLNB had a negative predictive value of 95% to 100%. Recurrent tumor at presentation, tumor arising from an area of chronic inflammation, and immunosuppression were significantly associated with increased risk of subsequent recurrence, with a mean follow‐up of 19.9 months.
Conclusions
SLNB can be used to identify regional lymph node metastases in cutaneous squamous cell carcinoma of the head and neck with a high negative predictive value (95%–100%). Factors associated with recurrence were tumor being locally recurrent at presentation, arising from an area of chronic inflammation, and immunosuppression.
Level of Evidence
4 Laryngoscope, 130:108–114, 2020
•TTMV-HPV DNA testing to aid HPV-positive OPSCC diagnosis was prospectively evaluated.•Testing was feasible and perceived as clinically useful by treating physicians.•Among 3 subjects diagnosed with ...HPV-positive OPSCC, 2 had detectable TTMV-HPV DNA.•Undetectable TTMV-HPV DNA may not reliably indicate absence of disease.•Clinicians using this test should be aware of both its strengths and limitations.
While survival outcomes are favorable for Human Papillomavirus (HPV)-positive oropharyngeal squamous cell carcinomas (OPSCCs), early diagnosis may minimize treatment-related morbidity and mortality. This study evaluated circulating tumor tissue-modified viral (TTMV)-HPV DNA plasma testing to facilitate early diagnosis of HPV-positive OPSCCs.
In this prospective exploratory cohort study, patients presenting to an Otolaryngology-Head and Neck Surgery clinic with unexplained signs or symptoms considered high-risk for HPV-positive OPSCC were recruited between March 2021-October 2022. Circulating TTMV-HPV DNA testing was performed, and results were shared with subjects and treating clinicians. Clinicians were surveyed regarding the perceived clinical utility of the test.
Thirty-nine subjects were included. Most subjects were women (N = 23, 59 %), white (N = 32, 82 %) and never-smokers (N = 20, 51 %) with median age 60 years. Circulating TTMV-HPV DNA was detected in 2/39 subjects, both subsequently diagnosed with HPV-positive OPSCC. Both were white men aged 70–80 years with a neck mass. One subject with undetectable TTMV-HPV DNA was also diagnosed with HPV-positive OPSCC through excisional neck mass biopsy. Other eventual diagnoses included 3 HPV-negative head and neck squamous cell carcinomas and 4 other malignancies. Testing was perceived as helpful in clinical decision-making for 26/38 (68 %) subjects, and useful for similar future patients for 32/37 (86 %) subjects.
Circulating TTMV-HPV DNA testing is feasible and holds potential as a diagnostic aid for HPV-positive OPSCC alongside standard clinical workup. Clinicians should be cognizant of its limitations, as a negative test does not necessarily indicate the absence of disease. Further studies to evaluate its utility are warranted.
Background Stethoscopes are contaminated with bacteria, but predictors of stethoscope disinfection frequency are unknown. We sought to describe health care provider stethoscope disinfection attitudes ...and practices and determine predictors of frequent disinfection. Methods We used an anonymous online survey of nurses, nurse practitioners, and physicians at a pediatric hospital. We assessed frequency and methods of disinfection, perceptions of contamination, and barriers to disinfection. Multivariate logistic regression models were used to identify independent predictors of disinfecting after every use. Results One thousand four hundred one respondents completed the survey: 76% believed that infection transmission occurs via stethoscopes, but only 24% reported disinfecting after every use. In multivariate analyses, belief that infection transmission occurs via stethoscopes significantly increased the odds of disinfection after every use (odds ratio OR, 2.06 95% confidence interval (CI): 1.38-3.06). The odds of disinfection after every use were significantly decreased in those who perceived the following barriers: lack of time (OR, 0.31 95% CI: 0.18-0.54), lack of access to disinfection material (OR, 0.41 95% CI: 0.29-0.57), or lack of visual reminders to disinfect (OR, 0.22 95% CI: 0.14-0.34). Conclusion Only a minority of pediatric health care providers reported disinfecting their stethoscopes after every use. Increasing access to disinfection materials and visual reminders in health care facilities may improve stethoscope disinfection practices.
Squamous cell carcinoma of the oropharynx (OPC) consists of human papillomavirus (HPV)-negative disease caused by tobacco and alcohol use, and HPV-positive disease caused by the sexually transmitted ...infection HPV. These entities have unique but overlapping risk factors, epidemiologic trends, staging systems, and survival outcomes. HPV-positive tumor status confers a significant survival benefit compared with HPV-negative disease. OPC treatment entails a combination of surgery, radiation, and chemotherapy. Ongoing trials will determine whether treatment of HPV-related disease may be safely deintensified to decrease morbidity. Emerging HPV-related biomarkers are under study as tools to inform screening, diagnosis, treatment, and surveillance for HPV-positive OPC.
Objectives/Hypothesis
Otologic complaints may place a significant burden on emergency departments (EDs) in the United States; however, few studies have comprehensively examined this discrete patient ...population. We aimed to identify utilization of EDs by patients with primary otologic complaints.
Study Design
Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011.
Methods
The NEDS database was queried for patient encounters with a primary otologic diagnosis based on International Classification of Diseases, Ninth Revision codes (380–389). Weighted estimates for demographics, diagnostic characteristics, socioeconomic status, and trends over time were extracted. Predictors of mortality and admission were determined by multivariable logistic regression.
Results
A weighted total of 8,611,282 visits between 2009 and 2011 were attributed to otologic diagnoses, representing 2.21% of all ED visits. Stratified by patient age, otologic diagnoses encompassed 1.01% and 6.79% of all adult and pediatric ED visits, respectively. The majority of patients were treated and released (98.17%). The average age of patients presenting with an otologic complaint was 17.9 years (standard error = 0.23). Overall, 62.7% of patients who presented with an otologic complaint were 0 to 17 years old. The most common diagnoses among all age groups included otitis media not otherwise specified (NOS) (60.6%), infected otitis externa NOS (11.8%), and otalgia NOS (6.8%).
Conclusions
We provide a comprehensive overview of otologic complaints that are an overlooked diagnostic category in public health research. NEDS data demonstrate a significant number of visits related to otologic complaints, especially in the pediatric population, that are nonemergent.
Level of Evidence
4 Laryngoscope, 125:1926–1933, 2015
Objectives/Hypothesis
Tracheoesophageal puncture (TEP) can be performed at the time of laryngectomy (primary) or postoperatively (secondary). Prior studies demonstrate safe and earlier voice ...acquisition and rehabilitation with primary TEP. The objectives of this study were to assess national trends in primary TEP and identify factors associated with its use.
Study Design
Retrospective review.
Methods
Retrospective analysis of the Nationwide Inpatient Sample (NIS) from 2010 to 2014 was performed. The NIS was queried for patients who underwent total laryngectomy (TL) (International Classification of Diseases, Ninth Revision, Clinical Modification ICD‐9‐CM 30.3–30.4) and primary TEP (ICD‐9‐CM 31.95). Patient demographics, comorbidities, and factors known to influence the decision to perform TEP were characterized. Factors associated with primary TEP were identified by multivariable regression.
Results
A total of 15,410 patients underwent TL during the study period. Of this cohort, 1,124 patients (7.3%) underwent primary TEP. Among patients who underwent primary TEP, 80.9% had laryngeal cancer, 16.4% had pedicled or free‐flap reconstruction at the time of TL, 4.2% underwent partial pharyngectomy, and 48.0% underwent cricopharyngeal myotomy (CPM). The majority of primary TEPs were performed at urban teaching hospitals (90.6%). In multivariable regression, patients who underwent CPM were at significantly increased odds of primary TEP (odds ratio: 3.79, P < .0001). Flap reconstruction, partial pharyngectomy, age, gender, history of laryngeal cancer, hospital region, and teaching status were not associated.
Conclusions
Primary TEP is associated with earlier voice restoration after TL but is infrequently performed. The majority of primary TEPs are performed in teaching hospitals, and primary TEP is associated with concurrent cricopharyngeal myotomy. Future studies should investigate practice patterns associated with primary TEP.
Level of Evidence
4. Laryngoscope, 128:2320–2325, 2018
Objectives/Hypothesis
Opioid‐related deaths in the United States have increased 200% since 2000, in part due to prescription diversion from patients who had a surgical procedure. The purpose of this ...study was to characterize provider prescription patterns and assess patient‐reported opioid use after endoscopic sinus surgery (ESS).
Study Design
Retrospective chart review.
Methods
Patients who underwent ESS between May 2017 and May 2018 were included. Opioid prescription, operative details, and postoperative opioid use data were extracted. The Massachusetts Prescription Awareness Tool (MassPAT) was queried to determine if patients filled their prescription.
Results
One hundred fifty‐five patients were included. Nearly all patients received an opioid prescription (94.8%). An average of 15.6 tablets was prescribed per patient. Among 116 patients with MassPAT data, 91.4% filled their prescription. Among 67 patients who reported the number of tablets they had used at the time of first follow‐up appointment, 73.1% reported taking no opioids. Mean number of tablets prescribed was significantly greater among patients who underwent primary versus revision surgery (16.5 vs. 13.5, P = .0111) and those who had splints placed (21.5 vs. 15.1, P = .0037). Predictors of opioid use included concurrent turbinate reduction (58.3% vs. 14.3%, P < .0001) and concurrent septoplasty (45.5% vs. 21.6%, P = .039).
Conclusions
Nearly all patients who underwent ESS were prescribed an opioid, and nearly all patients filled their prescription. However, the vast majority of patients did not require any opioid medication for postoperative pain control. As the opioid epidemic continues to persist, these findings have immediate relevance to current prescribing patterns and pain management practices.
Level of Evidence
4 Laryngoscope, 129:1046–1052, 2019
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