[Show abstract][Hide abstract] ABSTRACT: Direct laryngoscopy, once an inpatient procedure, is now commonly performed in the outpatient setting. To ensure that safety follows the adoption of novel techniques and practice patterns, it is important to analyze the complication and revisit rates of these ambulatory surgery practices.
To determine revisit rates and complications after ambulatory adult direct laryngoscopy procedures.
This was a retrospective cross-sectional analysis of cases of adult patients who had undergone a direct laryngoscopic procedure extracted from multistate ambulatory surgery and hospital databases (State Ambulatory Surgery Databases for New York, Florida, Iowa, and California for 2010 and 2011). The analysis was performed on December 1, 2014. Index cases were linked to the corresponding State Emergency Department Databases and the State Inpatient Databases for visit encounters occurring within a 7-day postoperative window. All index cases were ambulatory surgery, without overnight stay or 23-hour observation.
Adult patients who had undergone a direct laryngoscopy procedure.
Direct laryngoscopy performed in an ambulatory setting. Patients who underwent flexible laryngoscopy, lesion destruction, laryngectomy, cordectomy, or a secondary nonlaryngoscopy procedure were specifically excluded.
Data regarding sex, age, revisit occurrence with associated complications, and mortality were analyzed.
A total of 7743 cases of ambulatory laryngoscopy were identified (mean age, 60.4 years; 61% were male). The 7-day revisit rate was 3.0% (232 revisits). Serious airway complications occurred in 0.27% of cases (n = 21) and accounted for 9.1% of revisits. The rates of other major complications and minor complications were 0.15% (n = 12) and 0.75% (n = 58), respectively. There were no cases of anoxic brain injury. Two deaths occurred at the time of the revisit (7-day mortality rate, 0.03%; 95% CI, 0.01%-0.09%).
Adult ambulatory direct laryngoscopy has a favorable safety profile. Serious airway complications occur in fewer than 3 patients per 1000 cases. The risk of death following outpatient laryngoscopy is extremely low. Outpatient laryngoscopy is not universally suited for all patients, and careful preoperative selection and counseling are imperative.
JAMA Otolaryngology - Head and Neck Surgery 07/2015; 141(8). DOI:10.1001/jamaoto.2015.1172 · 1.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recurrent, rapidly growing nasal polyps are hallmarks of aspirin-exacerbated respiratory disease (AERD), though the mechanisms of polyp growth have not been identified. Fibroblasts are intimately involved in tissue remodeling, and the growth of fibroblasts is suppressed by prostaglandin E2 (PGE2), which elicits antiproliferative effects mediated through the E Prostanoid (EP)2 receptor. We now report that cultured fibroblasts from the nasal polyps of subjects with AERD resist this antiproliferative effect. Fibroblasts from polyps of AERD subjects resisted the antiproliferative actions of PGE2 and a selective EP2 agonist (P<0.0001 at 1µM) compared with nasal fibroblasts from aspirin tolerant control subjects undergoing polypectomy or from healthy control subjects undergoing concha bullosa resections. Cell surface expression of the EP2 receptor protein was lower in fibroblasts from AERD subjects than in fibroblasts from healthy controls and aspirin-tolerant subjects (P<0.01 for both). Treatment of the fibroblasts with trichostatin A (TSA), a histone deacetylase inhibitor, significantly increased EP2 receptor mRNA in fibroblasts from AERD and aspirin-tolerant subjects, but had no effect on COX-2, EP4 and mPGES1 mRNA levels. Histone acetylation (H3K27ac) at the EP2 promoter correlated strongly with baseline EP2 mRNA (r=0.80, P<0.01). These studies suggest that the EP2 promotor is under epigenetic control and one explanation for PGE2 resistance in AERD is an epigenetically mediated reduction of EP2 receptor expression which could contribute to the refractory nasal polyposis typically observed in this syndrome.
American Journal of Respiratory Cell and Molecular Biology 06/2015; DOI:10.1165/rcmb.2014-0486OC · 3.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives/HypothesisDetermine rates and reasons for revisits after adult uvulopalatopharyngoplasty (UPPP).Study DesignCross-sectional analysis of multistate ambulatory surgery and hospital databases.Methods
Ambulatory adult UPPP cases were extracted from the State Ambulatory Surgery Databases for New York, Florida, Iowa, and California for 2010. Cases were linked to the State Emergency Department Databases and the State Inpatient Databases for visit encounters occurring 0 to 14 days after the procedure. The number of revisits (including readmissions) was determined as well as the diagnosis at the revisit. The overall mortality rate and intervention rate for postprocedural bleeding were determined.ResultsA total of 2,349 ambulatory UPPP cases were extracted (mean age, 44.9 years). Overall, 9.7% of patients had a revisit after surgery (13.7% revisited the ambulatory surgery center, 68.3% the emergency department. and 18.1% to inpatient admission). The primary diagnoses at the first revisit were bleeding (38.3%), acute pain (21.2%), and fever/dehydration (6.6%). Overall, 1.6% of patients incurred a second revisit. Among all cases, 3.7% and 0.6% presented with a bleeding diagnosis at a first and second revisit, respectively. Among revisits, 11.5% and 26.3% underwent a procedure to control bleeding at the first and second revisits, respectively. One death occurred for an overall 14-day mortality rate of 0.043%.Conclusions
Ambulatory UPPP demonstrates an good postoperative safety profile. Postoperative hemorrhage and acute pain, as well as fever/dehydration, are common reasons for revisits. These particular complications should be targeted for prevention to reduce postoperative revisit rates.Level of Evidence2b Laryngoscope, 125:754-757, 2015
The Laryngoscope 03/2015; 125(3). DOI:10.1002/lary.24706 · 2.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Investigate the incidence and characteristics of revisits following ambulatory pediatric tonsillectomy/adenotonsillectomy. Cross-sectional study using national databases. Ambulatory pediatric (age <18.0 years) tonsillectomy or adenotonsillectomy cases were extracted from the 2010 State Ambulatory Surgery, Emergency Department, and Inpatient databases for New York, Florida, Iowa, and California. First and second revisits within the 14-day postoperative period were tabulated. Diagnoses, procedure codes, and mortality were examined. There were 36,221 pediatric tonsillectomies/adenotonsillectomies (mean age 7.4 years, 51.4% male). Overall, 2,740 patients (7.6%) had a revisit after pediatric tonsillectomy; 402 patients (1.1%) had a second revisit. Among revisits, 6.3% revisited the ambulatory surgery center, 77.5% revisited the emergency department, and 16.2% were readmitted as an inpatient. Among all tonsillectomies, bleeding occurred in 2.0% and 0.5% within the first and second revisits, respectively. A second revisit had a statistically higher association with a primary bleeding diagnosis than the first revisit (P < .001). Among all cases, 0.75% underwent a surgical procedure for bleeding at a first revisit compared to 0.25% during a second revisit. Acute pain was the primary diagnosis in 18.4% and 11.2% of first and second revisits; fever/vomiting/dehydration were primary diagnoses in 28.2% and 17.9%, respectively. There were two mortalities (0.0055%) within the 14-day postoperative interval. This large-scale analysis describes the current rates and diagnoses of revisits, hospital readmission, and surgical intervention following ambulatory pediatric tonsillectomy. Many revisits centered on pain control and dehydration, suggesting that more adequate symptom control may prevent a large proportion of revisits. 2b. Laryngoscope, 125:457–461, 2015
The Laryngoscope 02/2015; 125(2). DOI:10.1002/lary.24783 · 2.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The care of patients with head and neck cancer (HNCA) is becoming increasingly regionalized to high-volume, more effective centers. However, it remains uncertain whether such care is equally distributed. Increasing our understanding of how HNCA treatment is utilized among different sectors should improve strategy designs aimed at ensuring optimized quality of care.
To determine which patient- or treatment-associated factors may account for increased regionalization of HNCA care.
Secondary analysis of all inpatient records of hospital admissions with a primary HNCA diagnosis contained within the Nationwide Inpatient Sample during the calendar years 2000, 2005, and 2010.
Influence of comorbidities, payer, radiation therapy, and case complexity on regionalization of HNCA care to teaching institutions.
In the years 2000, 2005, and 2010, there were an estimated mean (SE) 28 862 (2067), 33 517 (3080), and 37 354 (4194) inpatient hospital HNCA stays, respectively, in the United States. Over time, the respective Charlson comorbidity index (CCI) scores (4.4 and 4.0) and Van Walraven scores (10.0 and 8.9) for nonteaching and teaching institutions were increasingly higher (P < .001). Payer status (private insurance vs Medicaid) did not change for teaching institutions (35.4% vs 33.3%) (P ≥ .63), but the proportion of Medicaid patients did increase over time for nonteaching institutions (10.2% vs 15.8%) (P = .002). Both teaching and nonteaching institutions saw an increase in proportion of prior irradiated cases (7.6% and 4.6% vs 3.4% and 1.9%, respectively) (P ≤ .02). The proportion of major ablative procedures was stable for teaching institutions over time (46.5% vs 43.3%) (P = .57) but decreased for nonteaching institutions (27.2% vs 32.6%) (P = .01). The proportion of flap reconstruction procedures increased over time for teaching institutions (8.6% vs 4.1%) (P < .001) but not for nonteaching institutions (2.7% vs 2.4%) (P = .21).
Despite the demonstrated link between excellence and outcomes and specialized resource-intensive care, the regionalization of head and neck oncologic treatment is becoming increasingly divergent, and the neediest, sickest patient groups are receiving less than optimal care.
JAMA Otolaryngology - Head and Neck Surgery 01/2015; 141(4). DOI:10.1001/jamaoto.2014.3603 · 1.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Quantify the relationships between dizziness, falls, and obesity among adults. Cross-sectional analysis of a national health survey. Adult respondents in the 2008 National Health Interview Survey balance module were analyzed. With demographic information, data for balance and dizziness problems, reported falls, injuries from falls, and body mass index were extracted. Associations between balance/dizziness problems and falls or injuries from falls were determined. The additional association between obesity and falls or fall-related injuries in the setting of a balance/dizziness problem was determined. Among 216.8 ± 3.5 million adult Americans, 24.2 ± 0.7 million reported dizziness in the past 12 months (11.1% ± 0.3%; mean age, 45.9 ± 0.2 years; 51.7% ± 0.5% female), 11.5% ± 0.3% had fallen in the prior 12 months, and 26.3% ± 0.4% were obese. Among individuals reporting dizziness, 34.3% ± 1.3% reported falls, whereas only 9.1% ± 0.3% of nondizzy individuals reported a fall (odds ratio [OR]: 5.1; P < .001). Among dizzy individuals who reported a fall, 45.8% ± 2.1% were injured by the fall versus 35.6% ± 1.4% nondizzy individuals who fell (OR: 1.5; P < .001). The addition of obesity to dizziness increased the odds of falling by 1.3 (95% confidence interval: 1.2-1.5; P < .001) but did not significantly increase the odds of fall-related injury (P = .110). Dizziness/balance problems are strongly associated with both an increased tendency to fall and increased injury rate from falls among adults. The addition of obesity to dizziness was associated with a higher rate of falling but was not associated with a significantly higher rate of fall-related injury. Balance problems in conjunction with obesity need to be targeted in fall-prevention efforts. 2b. Laryngoscope, 124:2797–2801, 2014
The Laryngoscope 12/2014; 124(12). DOI:10.1002/lary.24806 · 2.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Determine if disparities exist for revisit complications after adult tonsillectomy.Methods
Cases of adult tonsillectomy were extracted from the state ambulatory surgery databases and linked to the state emergency department databases and inpatient databases for California, Iowa, Florida and New York for 2010 and 2011. Revisits within 14 days for diagnoses of: post-tonsillectomy bleeding, acute pain and nausea/vomiting/dehydration were determined and analyzed for associations of these complications with age, sex, race, median household income and comorbidity score.ResultsAmong 17,836 tonsillectomies (63.7% female; mean age, 29.0 years), revisit rates for post-tonsillectomy bleeding, acute pain and fever/dehydration were 5.1%, 2.8% and 1.5%, respectively. On multivariate analysis, only female sex was associated with a lower post-tonsillectomy bleeding rate (odds, 0.48, p < 0.001). Decreasing household income, female sex, black and Hispanic race were associated with increased revisits for acute pain (odds, 1.21, 1.49, 2.03 and 1.32, p ≤ 0.002). Female sex was associated with an increased odds of a revisit for FNVD (odds, 1.94, p < 0.001).Conclusions
Significant disparities with respect to income and race exist in the incidence of revisits and potentially avoidable complications after adult tonsillectomy.
American Journal of Otolaryngology 11/2014; 36(2). DOI:10.1016/j.amjoto.2014.11.004 · 0.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives/HypothesisDetermine the prevalence of smell disturbance and taste disturbance and associated factors in adults.Study DesignCross-sectional analysis of nationwide household health survey.Methods
Data from the taste and smell disorders component of the National Health and Nutrition Examination Survey (NHANES) 2011 to 2012 were examined. The prevalence of self-reported problems with taste and/or smell among adults and the associated symptom frequency, related healthcare provider interactions, and symptoms/etiologies (e.g., persistent cold/flu, dry mouth, or head injury, etc.) were determined. Associations between sex and age with smell and taste disturbances as well as the relationship between smell and taste disturbances were determined.ResultsAmong 142.5 ± 12.6 million adult Americans (raw N = 3,594), there were an estimated 15.1 ± 2.1 million individuals (10.6% ± 1.0%) with self-reported smell disturbance in the prior 12 months. Sex was not associated with the prevalence of self-reported smell disturbance (P = 0.146), but increasing age was associated with an increasing prevalence of smell disturbance (odds ratio [OR] 1.147; 95% confidence interval [CI], 1.003–1.312). An estimated 7.5 ± 0.6 million individuals (5.3% ± 0.3%) reporting a problem with taste in the prior 12 months. Sex was not associated with the prevalence of taste disturbance (P = 0.947) but increasing age was (OR 1.202; 1.037–1.395). Among 19.4 ± 2.2 million reporting smell and/or taste abnormality, 20.2% ± 2.3% discussed this with a healthcare provider and 5.8% ± 1.4% felt it interfered with their daily life.ConclusionA significant number of adult Americans report problems with smell disturbance and taste disturbance. Further work to identify patients whose smell or taste disturbance can be helped is warranted.Level of Evidence2b. Laryngoscope, 2014
The Laryngoscope 11/2014; 125(5). DOI:10.1002/lary.24999 · 2.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives/HypothesisForeign body aspiration (FBA) continues to be a concerning pediatric problem, accounting for thousands of emergency room visits and more than 100 deaths each year in the United States. The costs incurred with hospitalizations and procedures following these events are the focus of this study.Study DesignRetrospective review.Methods
The Nationwide Inpatient Sample from 2009 to 2011 was analyzed, and all cases with pediatric bronchial foreign body aspirations (International Classification of Diseases-9 codes: 934.0, 934.1, 934.8, and 934.9) were reviewed. Cases were analyzed to determine type of foreign body aspiration, procedural interventions performed, duration of inpatient stay, mortality rate, complications, and posthospitalization disposition. The median length of hospital stay and total costs associated with aspiration events were determined.ResultsAn estimated 1,908 ± 273 pediatric bronchial FBA patients were admitted annually over the 3-year period (mean age, 3.6 ± 0.3 years; 61.3% ± 1.9% male). The ratio of foreign object aspiration to food aspiration was 5:3. Overall, 56%.0 ± 3.6% of the patients underwent a bronchoscopic procedure for foreign body removal; of those, 41.5% ± 2.5% had a foreign body removed at the time of the endoscopy. The hospital mortality rate associated with bronchial aspiration was 1.8% ± 0.4%; and 2.2% ± 0.5% of patients were diagnosed with anoxic brain injury. The median length of stay was 3 days (25th–75th interquartile range, 1–7 days).The median charges and actual costs per case were $20,820 ($10,800–$53,453) and $6,720 ($3,628–$16,723), respectively.Conclusion
The annual overall inpatient cost associated with pediatric bronchial foreign-body aspiration is approximately $12.8 million. Combined, the rate of death or anoxic brain injury associated with pediatric foreign body is approximately 4%.Level of Evidence2C. Laryngoscope, 2014
The Laryngoscope 10/2014; 125(5). DOI:10.1002/lary.25002 · 2.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives/HypothesisDetermine the incremental costs associated with head and neck cancer (HNCa) and compare the costs with other common cancers. Study DesignCross-sectional analysis of a healthcare expenditure database. Methods
The Medical Expenditure Panel Survey is a national survey of US households. All cases of HNCa were extracted for 2006, 2008, and 2010. The incremental expenditures associated with HNCa were determined by comparing the healthcare expenditures of individuals with HNCa to the population without cancer, controlling for age, sex, education, insurance status, marital status, geographic region, and comorbidities. Healthcare expenditures for HNCa were then compared to individuals with lung cancer and colon cancer to determine relative healthcare expenditures. ResultsAn estimated 264,713 patients (annualized) with HNCa were identified. The mean annual healthcare expenditures per individual for HNCa were $23,408$3,397 versus $3,860$52 for those without cancer. The mean adjusted incremental cost associated with HNCa was $15,852 +/-$3,297 per individual (P<.001). Within this incremental cost, there was an increased incremental outpatient services cost of $3,495 +/-$1,044 (P=.001) and an increased incremental hospital inpatient cost of $6,783 +/-$2,894 (P=.020) associated with HNCa. The annual healthcare expenditures per individual fell in between those for lung cancer ($25,267 +/-$2,375, P=.607) and colon cancer ($16,975 +/-$1,291, P=.055). Conclusions
Despite its lower relative incidence, HNCa is associated with a significant incremental increase in annual healthcare expenditures per individual, which is comparable to or higher than other common cancers. In aggregate, the estimated annual costs associated with HNCa are $4.20 billion.
The Laryngoscope 10/2014; 124(10). DOI:10.1002/lary.24795 · 2.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives/HypothesisDetermine the prevalence of voice problems and types of voice disorders among adults in the United States. Study DesignCross-sectional analysis of a national health survey. Methods
The 2012 National Health Interview Survey was analyzed, identifying adult cases reporting a voice problem in the preceding 12 months. In addition to demographic data, specific data regarding visits to healthcare professionals for voice problems, diagnoses given, and severity of the voice problem were analyzed. The relationship between voice problems and lost workdays was investigated. ResultsAn estimated 17.90.5 million adults (mean age, 49.1 years; 62.9%1.2% female) reported a voice problem (7.6%+/- 0.2%). Overall, 10.0%+/- 0.1% saw a healthcare professional for their voice problem, and 40.3%+/- 1.8% were given a diagnosis. Females were more likely than males to report a voice problem (9.3%+/- 0.3% vs. 5.9%+/- 0.3%, P<.001). Overall, 22% and 11% reported their voice problem to be a moderate or a big/very big problem, respectively. Infectious laryngitis was the most common diagnosis mentioned (685,000 +/- 86,000 cases, 17.8%+/- 2.0%). Gastroesophageal reflux disease was mentioned in 308,000 +/- 54,000 cases (8.0%+/- 1.4%). The mean number of days affected with the voice problem in the past year was 56.2 +/- 2.6 days. Respondents with a voice problem reported 7.4 +/- 0.9 lost workdays in the past year versus 3.4 +/- 0.1 lost workdays for those without (contrast, +4.0 lost workdays; P<.001). Conclusions
Voice problems affect one in 13 adults annually. A relative minority seek healthcare for their voice problem, even though the self-reported subjective impact of the voice problem is significant. Level of Evidence4 Laryngoscope 124:2359-2362, 2014
The Laryngoscope 10/2014; 124(10). DOI:10.1002/lary.24740 · 2.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective. To determine the prevalence of dysphagia, reported etiologies, and impact among adults in the United States. Study Design. Cross-sectional analysis of a national health care survey. Subjects and Methods. The 2012 National Health Interview Survey was analyzed, identifying adult cases reporting a swallowing problem in the preceding 12 months. In addition to demographic data, specific data regarding visits to health care professionals for swallowing problems, diagnoses given, and severity of the swallowing problem were analyzed. The relationship between swallowing problems and lost workdays was assessed. Results. An estimated 9.44 +/- 0.33 million adults (raw N = 1554; mean age, 52.1 years; 60.2% +/- 1.6% female) reported a swallowing problem (4.0% +/- 0.1%). Overall, 22.7% +/- 1.7% saw a health care professional for their swallowing problem, and 36.9% +/- 0.1.7% were given a diagnosis. Women were more likely than men to report a swallowing problem (4.7% +/- 0.2% versus 3.3% +/- 0.2%, P < .001). Of the patients, 31.7% and 24.8% reported their swallowing problem to be a moderate or a big/very big problem, respectively. Stroke was the most commonly reported etiology (422,000 +/- 77,000; 11.2% +/- 1.9%), followed by other neurologic cause (269,000 +/- 57,000; 7.2% +/- 1.5%) and head and neck cancer (185,000 +/- 40,000; 4.9% +/- 1.1%). The mean number of days affected by the swallowing problem was 139 +/- 7. Respondents with a swallowing problem reported 11.6 +/- 2.0 lost workdays in the past year versus 3.4 +/- 0.1 lost workdays for those without a swallowing problem (contrast, 18.1 lost workdays, P < .001). Conclusion. Swallowing problems affect 1 in 25 adults, annually. A relative minority seek health care for their swallowing problem, even though the subjective impact and associated workdays lost with the swallowing problem are significant.
Otolaryngology Head and Neck Surgery 09/2014; 151(5). DOI:10.1177/0194599814549156 · 2.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: (1) Determine if there is significant geographic variation in surgical charges for endoscopic sinus surgery (ESS) across states. (2) Understand factors that influence charges.
Otolaryngology Head and Neck Surgery 09/2014; 151(1 Suppl):P137-P138. DOI:10.1177/0194599814541629a2 · 2.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives/HypothesisDetermine the prevalence of pediatric voice and swallowing problems in the United States.Methods
The 2012 National Health Interview Survey pediatric voice and language module was analyzed, identifying children reporting a voice or swallowing problem in the preceding 12 months. In addition to demographic data, specific data regarding visits to health care professionals for voice or swallowing problems, diagnoses given, and severity of voice or swallowing problem were analyzed.ResultsAn estimated 839 ± 89 thousand children (1.4% ± 0.1%) reported a voice problem. Overall, 53.5% ± 1.9% were given a diagnosis for the voice problem and 22.8% ± 4.6% received voice services. Laryngitis (16.6% ± 5.5%) and allergies (10.4% ± 4.0%) were the most common diagnoses. A total of 16.4% graded the voice problem as a “big” or “very big” problem. An estimated 569 ± 63 thousand children (0.9% ± 0.1%) reported a swallowing problem. A total of 12.7% ± 3.8% received swallowing services and 13.4% ± 1.6% were given a diagnosis for their swallowing problem. Neurological problems were the most common diagnoses (11.1% ± 4.5%). A total of 17.9% graded the swallowing problem as a “big” or “very big” problem.Conclusion
These data provide the first insight into the prevalence of childhood voice and swallowing problems, which affect approximately 1% of children annually. A relative minority seek care for their problem, despite the disease impact.Level of Evidence4. Laryngoscope, 2014
The Laryngoscope 09/2014; 125(3). DOI:10.1002/lary.24931 · 2.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: Determine rates and reasons for revisits after adult ambulatory sinonasal surgery. Study design: Cross-sectional analysis of multi-state ambulatory surgery and hospital databases. Methods: Ambulatory adult sinonasal procedures were extracted from the State Ambulatory Surgery Databases for New York, Florida, Iowa and California for 2010. Cases were linked to the State Emergency Department Databases and the State Inpatient Databases for visit encounters occurring 0 to 14 days after the procedure. The number of revisits (including readmissions) was determined as well as the reason for revisit. The overall rate of and intervention rate for post-procedural bleeding were determined. Results: 35,678 ambulatory sinonasal cases were extracted (mean age, 47.5 years). Overall, 5.0% of patients had a revisit after surgery (18.9% revisited the ambulatory surgery center, 67.0% the emergency department and 14.1% to inpatient admission). The primary diagnoses at the first revisit were bleeding (23.0%), acute pain (3.7%) and fever/dehydration (3.8%). Overall, 0.8% of patients incurred a second revisit. Among all cases, 1.2% and 0.3% presented with a bleeding diagnosis at a first and second revisit, respectively. Among revisits, 1.0% and 17.9% underwent a procedure to control bleeding at the first and second revisits, respectively. Three deaths were noted for an overall 14 day mortality rate of 0.0084%. Conclusion: There is a non-negligible revisit rate after ambulatory sinonasal surgery. The most common reasons for revisit include bleeding, but also acute pain and fever/dehydration. These particular complications should be targeted for prevention to reduce postoperative revisit rates.
The Laryngoscope 09/2014; 124(9). DOI:10.1002/lary.24584 · 2.14 Impact Factor