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Tran T, Staibano P, Snidvongs K, Nguyen TBV, Sommer DD. Extent of Endoscopic Sinus Surgery in Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis. Curr Allergy Asthma Rep 2024; 24:639-650. [PMID: 39249643 DOI: 10.1007/s11882-024-01175-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2024] [Indexed: 09/10/2024]
Abstract
PURPOSE OF REVIEW There is an incomplete understanding regarding the extent of endoscopic sinus surgery (ESS) in managing chronic rhinosinusitis (CRS) and its effect on outcomes. This study aimed to assess and compare limited sinus surgery, full-house, extended and radical ESS for optimizing CRS outcomes. RECENT FINDINGS An online search in adherence with PRISMA guidelines was performed. Data were pooled for meta-analysis. Forty-six articles met inclusion criteria. Full-house ESS yielded greater improvements in SNOT-22 and endoscopy scores over limited ESS. Radical ESS improved nasal symptoms and reduced disease recurrence more than full house ESS, while extended ESS decreased revision ESS rates when compared to full-house ESS. Total ethmoidectomy reduced SNOT-22 scores more than limited ethmoidectomy. There was no difference in perioperative complications for all extents of ESS. When compared to limited ESS, full-house ESS yielded better patient symptom outcomes. Radical ESS demonstrated even greater reductions in nasal symptoms, while extended ESS additionally decreased revision surgery rates. Thus, in general, greater extent of ESS leads to better outcomes, while all extents of ESS are relatively safe.
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Affiliation(s)
- Thinh Tran
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Department of Otolaryngology, Head and Neck Surgery, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Phillip Staibano
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Methodology, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Kornkiat Snidvongs
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | - Thomas B V Nguyen
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Doron D Sommer
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Weber RK, Deitmer T, Löhler J, Aletsee C, Baumann I, Betz C, Beule A, Böscke R, Dietz A, Harnischmacher V, Haubner F, Heppt W, Hoffmann AS, Hoffmann TK, Hosemann W, Kühnel T, Laudien M, Olzowy B, Seibert KV, Sommer F, Verse T, Wiegand S, Hildenbrand T. [Survey on the use of nasal tamponades in sinunasal surgery]. Laryngorhinootologie 2024. [PMID: 39348844 DOI: 10.1055/a-2351-1500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
OBJECTIVE Currently, there is an intensive discussion about enhancing and expanding outpatient rhinosurgical procedures. Many questions about how to stratify into out- and inpatient procedures are still not sufficiently clarified. Particularly, the use of nasal packing materials is not adequately discussed. MATERIAL AND METHODS We performed a Germany-wide survey among otorhinolaryngologists regarding the use of nasal packing materials in sinonasal surgery. Additionally, we asked for any complication in relation to nasal packing. RESULTS In 85,6% nasal packing was used for septal and turbinate surgery at least occasionally, in 44,2% always. In sinus surgery these numbers are 94,1% and 49%, respectively. Non-resorbable nasal packing materials were predominantly used.Most frequent complications were bleeding with nasal packing in situ (> 50% of respondents) and posterior dislocation (24% of respondents), requiring emergency treatment. Death was listed in 5 patients. One patient suffered from permanent brain damage due to hypoxia. CONCLUSIONS Application of non-resorbable nasal packing materials with occlusion of the nasal cavity carry a substantial risk of complications, which necessitate emergency treatment, thus requiring inpatient care.
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Affiliation(s)
- Rainer K Weber
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
- Sinus Academy, Karlsruhe
| | - Thomas Deitmer
- Deutsche Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie e.V., Bonn, Deutschland
| | - Jan Löhler
- Deutscher Berufsverband der HNO-Ärzte e.V., Neumünster
| | | | - Ingo Baumann
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum, Heidelberg, Germany
| | - Christian Betz
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Achim Beule
- Klinik für HNO-Heilkunde, Universitätsklinikum Münster, Münster
| | - Robert Böscke
- Klinik für Hals-Nasen-Ohren-Heilkunde, Medizinischer Campus der Carl-von-Ossietzky Universität Oldenburg, Evangelisches Krankenhaus Oldenburg, Oldenburg
| | - Andreas Dietz
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Plastische Operationen, Universität Leipzig, Leipzig, Germany
| | | | - Frank Haubner
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum der LMU München, München, Germany
| | - Werner Heppt
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | | | - Thomas K Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde und Kopf-Hals-Chirurgie, Universitätsklinikum Ulm, Ulm, Germany
| | - Werner Hosemann
- Klinik für Hals-Nasen-Ohren-Heilkunde, Heliosklinikum, Stralsund
| | - Thomas Kühnel
- Klinik für Hals-Nasen-Ohrenheilkunde, Universität Regensburg, Regensburg
| | - Martin Laudien
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Christian-Albrechts-Universität Kiel, Kiel, Germany
| | | | | | - Fabian Sommer
- Klinik für Hals-Nasen-Ohrenheilkunde und Kopf-Hals-Chirurgie, Universitätsklinikum Ulm, Ulm, Germany
| | - Thomas Verse
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Asklepios Klinikum Harburg, Hamburg
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Plastische Operationen, Universität Leipzig, Leipzig, Germany
- Klinik für Hals-, Nasen-, Ohrenheilkund, Kopf- und Halschirurgie, Christian-Albrechts-Universität Kiel, Kiel, Germany
| | - Tanja Hildenbrand
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
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Weber RK, Deitmer T, Löhler J, Aletsee C, Baumann I, Betz C, Beule A, Böscke R, Dietz A, Harnischmacher V, Haubner F, Heppt W, Hoffmann AS, Hoffmann TK, Hosemann W, Kuehnel T, Laudien M, Olzowy B, Seibert KV, Sommer F, Verse T, Wiegand S, Hildenbrand T. [Sinunasal surgery as outpatient procedure with special consideration of nasal packing - Position paper of the German Society of Otorhinolaryngology, Head and Neck Surgery, the working group Rhinology / Rhinosurgery (ARHIN) of the German Society of Otorhinolaryngology, Head and Neck Surgery and German Professional Association of Otorhinolaryngologists]. Laryngorhinootologie 2024. [PMID: 39348843 DOI: 10.1055/a-2353-2347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
OBJECTIVE Currently, there is an intensive discussion on advancing and expanding outpatient rhinosurgical procedures. Many questions about how to stratify into out- and inpatient procedures are still not sufficiently clarified. Particularly, the use of nasal packing materials is not adequately discussed. MATERIAL AND METHODS Development of a checklist to stratify sinunasal procedures into in- or outpatient procedures with consideration of current scientific literature and risk factors. RESULTS AND CONCLUSIONS After comprehensive assessment of the literature and analysis of specific risk factors, a list of sinunasal procedures is presented, which should be performed as inpatient procedures. We present a checklist for in- and outpatient sinunasal procedures, which considers social, medical and surgical factors as well as the use of nasal packing materials. Furthermore, a checklist is added to assess, whether patients are ready for discharge after a planned outpatient procedure.
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Affiliation(s)
- Rainer K Weber
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
- Sinus Academy, Karlsruhe
| | - Thomas Deitmer
- Deutsche Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie e.V., Bonn, Deutschland
| | - Jan Löhler
- Deutscher Berufsverband der HNO-Ärzte e.V., Neumünster
| | | | - Ingo Baumann
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum, Heidelberg, Germany
| | - Christian Betz
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Achim Beule
- Klinik für HNO-Heilkunde, Universitätsklinikum Münster, Münster
| | - Robert Böscke
- Klinik für Hals-Nasen-Ohren-Heilkunde, Medizinischer Campus der Carl-von-Ossietzky Universität Oldenburg, Evangelisches Krankenhaus Oldenburg, Oldenburg
| | - Andreas Dietz
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitatsklinikum Leipzig, Leipzig, Germany
| | | | - Frank Haubner
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum der LMU München, München, Germany
| | - Werner Heppt
- Klinik für Hals-Nasen-Ohren-Heilkunde, Städtisches Klinikum, Karlsruhe
| | | | - Thomas K Hoffmann
- Klinik für Hals, Nasen- und Ohrenheilkunde und Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Werner Hosemann
- Klinik für Hals-Nasen-Ohren-Heilkunde, Heliosklinikum, Stralsund
| | - Thomas Kuehnel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Martin Laudien
- Klinik für Hals-, Nasen-, Ohrenheilkund, Kopf- und Halschirurgie, Christian-Albrechts-Universität Kiel, Kiel, Germany
| | | | | | - Fabian Sommer
- Klinik für Hals, Nasen- und Ohrenheilkunde und Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Thomas Verse
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Asklepios Klinikum Harburg, Hamburg
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Plastische Operationen, Universität Leipzig, Leipzig, Germany
- Klinik für Hals-, Nasen-, Ohrenheilkund, Kopf- und Halschirurgie, Christian-Albrechts-Universität Kiel, Kiel, Germany
| | - Tanja Hildenbrand
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitatsklinikum Freiburg, Freiburg, Germany
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Rubin F, Fink J, Jonzo M, Al Assaf W, Vellin JF. Analysis of endonasal sinus surgery in a private outpatient setting in a tropical environment: A STROBE analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:197-202. [PMID: 38401995 DOI: 10.1016/j.anorl.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
OBJECTIVES To evaluate results and failure factors in endonasal surgery in a private outpatient setting in a tropical environment. MATERIAL AND METHOD A single-center observational study included 337 patients consecutively undergoing endonasal surgery in a private hospital on Réunion Island, a French overseas administrative Département in the Indian Ocean between 2019 and 2021. The main objective was to assess the success rate of the outpatient pathway. Secondary objectives comprised analysis of complications and identification and management of factors for failure of outpatient management. The study was conducted according to the STROBE editorial guideline. RESULTS The 337 surgeries notably comprised 112 septoplasties (37.5%), 104 meatotomies (30.3%), 15 unilateral total ethmoidectomies (4.6%), 48 bilateral total ethmoidectomies with sphenoidotomy (14.3%), and 18 Draf procedures (5.5%). Seventy-five percent of patients (252/337) were operated on as outpatients, with a success rate of 90% (227/252 patients). The rate of severe intraoperative complications was 1.5% (5/337). On multivariate analysis, 3 variables were identified as influencing risk of failure of the outpatient pathway: emergency analgesia in the operating room [odds ratio (OR): 91.61; 95% confidence interval (CI): 22.8-540.3], operating time (OR: 1.05; 95% CI: 1.01-1.09), and recovery room time (OR: 1.02; 95% CI: 1.01-1.03). CONCLUSION Our study in a tropical environment found eligibility and success rates for outpatient endonasal surgery similar to those in metropolitan France. This makes surgical and anesthesiological training a key factor in the success of outpatient care, while the location of the care structure and the climate seem to have little impact.
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Affiliation(s)
- F Rubin
- Département de Chirurgie ORL, Clinique Saint-Vincent, 8, rue de Paris, 97400 Saint-Denis, Reunion.
| | - J Fink
- Département d'Anesthésie-Réanimation, Clinique des Orchidées, Parc de l'Oasis, 30, avenue Lénine, 97420 Le Port, Reunion
| | - M Jonzo
- Unité de Recherche Clinique, Clinique Saint-Vincent, 8, rue de Paris, 97400 Saint-Denis, Reunion
| | - W Al Assaf
- Département de Chirurgie ORL, Clinique Saint-Vincent, 8, rue de Paris, 97400 Saint-Denis, Reunion
| | - J-F Vellin
- Département de Chirurgie ORL, Clinique Saint-Vincent, 8, rue de Paris, 97400 Saint-Denis, Reunion
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de Gabory L, Portmann D, Kérimian M. A short history of nasal polyposis. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:325-327. [PMID: 37865532 DOI: 10.1016/j.anorl.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Nasal polyposis was initially considered a tumor, but came to be seen as a chronic inflammatory mucosal disease during the second half of the 20th century. Although pathogenesis remains unclear, this has not prevented progress in diagnosis and treatment, both surgical and medical, based on the hypotheses of chronic rhinosinusitis with type-2 inflammation and autoimmune inflammation maintained by the vestigial olfactory mucosa of the ethmoid.
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Affiliation(s)
- L de Gabory
- Service d'ORL et Chirurgie Cervico-Faciale, Centre François Xavier Michelet, CHU de Bordeaux, Bordeaux, France; Université de Bordeaux, Bordeaux 33000, France; Institut Georges Portmann, 114, avenue D'Ares, 33000 Bordeaux, France.
| | - D Portmann
- Institut Georges Portmann, 114, avenue D'Ares, 33000 Bordeaux, France
| | - M Kérimian
- Service d'ORL et Chirurgie Cervico-Faciale, Centre François Xavier Michelet, CHU de Bordeaux, Bordeaux, France; Institut Georges Portmann, 114, avenue D'Ares, 33000 Bordeaux, France
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Löhler J, Delank W, Drumm S, Jäckel M, Lundershausen D, Mlynski R, Rotter N, Zeise K, Guntinas-Lichius O, Deitmer T. Erwägungen zur Durchführung und Qualitätssicherung ambulanter Operationen im HNO-Bereich in Deutschland. Laryngorhinootologie 2022; 101:866-875. [DOI: 10.1055/a-1946-1458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Zusammenfassung
Hintergrund Die deutsche Gesundheitspolitik hat eine Ausweitung ambulanter Operationen und Verfahren propagiert und die Diskussion darüber eingeleitet. Die HNO-Heilkunde bietet Möglichkeiten, derzeit stationär durchgeführte Eingriffe ambulant zu erbringen.
Methoden Die Deutsche Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie und der Deutsche Berufsverband der HNO-Ärzte haben Arbeitsgruppen ins Leben gerufen, die die HNO-fachlichen Aspekte der Leistungsverlagerungen in den ambulanten Bereich beurteilen und bewerten sollen. Die Arbeitsgruppen bekamen den Auftrag dabei organisatorische, strukturelle und personelle Definitionen der Qualitätssicherung zu erarbeiten und zu berücksichtigen.
Empfehlung Es wurden ausführlich Tatbestände bestimmt, die eine ambulante Operation im HNO-Fachgebiet ausschließen. Grundlage bildeten hierbei sowohl operationsbedingte als auch patientenbedingte Tatbestände. Schließlich wurden Operationen benannt, die als ambulante Operationen durchgeführt werden können.
Diskussion Es erfolgte eine HNO-fachliche Bewertung. Voraussetzung für eine Ambulantisierung ist eine Neuordnung der Vergütung. Das bisherige DRG- und EBM-System bieten hierzu keinen befriedigenden Rahmen, der EBM ermöglicht keine wirtschaftliche Erbringung operativer Eingriffe im HNO-Bereich. Die Entwicklung eines adäquaten Finanzierungsmodells ist für einen Erfolg der Umsetzung genauso zwingend erforderlich wie die Integration und Finanzierung der HNO-ärztlichen Weiterbildung.
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Affiliation(s)
- Jan Löhler
- Wissenschaftliches Institut für angewandte HNO-Heilkunde (WIAHNO), Bad Bramstedt
| | - Wolfgang Delank
- Hals-Nasen-Ohren-Klinik, Klinikum Ludwigshafen, Ludwigshafen
| | - Stefan Drumm
- Gemeinschaftspraxis für Hals-Nasen-Ohrenheilkunde, Adendorf
| | | | | | - Robert Mlynski
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie „Otto Körner“, Universitätsmedizin Rostock, Rostock
| | - Nicole Rotter
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Mannheim
| | | | - Orlando Guntinas-Lichius
- HNO-Klinik, Universitätsklinikum Jena, Jena
- Deutsche Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie, Bonn
| | - Thomas Deitmer
- Deutsche Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie, Bonn
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Lecanu JB, Pages L, Lazard D, Sain Oulhen C. Outpatient bilateral ethmoidectomy in a private non-profit structure: Retrospective study of 204 patients. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 139:13-16. [PMID: 34083168 DOI: 10.1016/j.anorl.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The main objective of this study was to determine the rate of outpatient management in a population of patients undergoing bilateral ethmoidectomy. The secondary objectives were to evaluate the quality of outpatient management (rate of unscheduled overnight admission, readmission rate, complications) and to compare inpatient and outpatient groups to determine which elements of the phenotype and care pathway favored outpatient management. MATERIALS AND METHODS A single-center observational study included 204 patients operated on for bilateral ethmoidectomy. Study variables comprised: type of care pathway (outpatient/inpatient), outpatient quality indicators (unscheduled admission, readmission, complications), care pathway, and population characteristics. RESULTS One hundred and twenty (58.8%) outpatients were operated on. No deaths occurred. The unscheduled admission rate was 7.5%, and the readmission rate 4.1%; at the P<0.005 threshold, there were no significant differences between in- and out-patient groups. Outpatients had earlier surgery (P<0.005), and nasal packing rates and pain on VAS were lower (P<0.005). CONCLUSION Ethmoidectomy could be carried out as an outpatient procedure in 58.8% of cases, with acceptable quality of care. Selection of patients and the organization of a dedicated care pathway seem to be elements favoring this management.
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Affiliation(s)
- J-B Lecanu
- Service d'ORL et de Chirurgie Cervico Faciale, Institut Arthur Vernes, 36, rue d'Assas, 75006 Paris, France.
| | - L Pages
- Service d'ORL et de Chirurgie Cervico Faciale, Institut Arthur Vernes, 36, rue d'Assas, 75006 Paris, France
| | - D Lazard
- Service d'ORL et de Chirurgie Cervico Faciale, Institut Arthur Vernes, 36, rue d'Assas, 75006 Paris, France
| | - C Sain Oulhen
- Service d'ORL et de Chirurgie Cervico Faciale, Institut Arthur Vernes, 36, rue d'Assas, 75006 Paris, France
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Deitmer T, Dietz A, Delank KW, Plontke SK, Welkoborsky HJ, Dazert S. [Outpatient Surgery in German ENT]. Laryngorhinootologie 2021. [PMID: 33822330 DOI: 10.1055/a-1418-9745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Currently there is an intense discussion ongoing to enhance and expand outpatient surgery in the ENT in Germany, which is the intention by several politicians. The goal is to achieve a frequency of outpatient surgery comparable to an international level.To achieve this goal, acceptance of outpatient interventions by both, surgeons and patients is required, particularly in regard of equal quality standards and patient safety requirements.In the following review the organization, outcome, quality management and strategies for different ENT outpatient surgery worldwide is analyzed. Basically, outpatient surgery is organized in different ways: office-based-procedures in local anesthesia, procedures in ambulatory surgery center settings as standalone facilities or in connection with and adjacent to a hospital with possible inpatient treatment. Contact and resident times of the patients in the outpatient surgery centers differ between some hours through 23 hours. A deliberated and careful selection of patients which are suitable for outpatient procedures is required and should address comorbidities, medications, social circumstances, health literacy of the patient and its relatives, and distance from home to the hospital. A careful and strict quality management is mandatory which comprises the entire process from patient selection through patient entry, surgery, discharge and postoperative care in a multidisciplinary setting.Zur besseren Lesbarkeit des Textes wird bei geschlechterbezogenen Bezeichnungen die männliche Form benutzt. Es sind jedoch in gleicher Rangfolge auch das jeweilige weibliche Geschlecht oder andere Geschlechtsausprägungen gemeint.
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Affiliation(s)
- Thomas Deitmer
- Deutsche Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie, Bonn, Germany
| | - Andreas Dietz
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Plastische Operationen, Universität Leipzig, Leipzig, Germany
| | - K-Wolfgang Delank
- HNO-Klinik, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany
| | - Stefan K Plontke
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - H-J Welkoborsky
- Klinik für HNO-Heilkunde, regionale plastische Chirurgie, Kopf- und Halschirurgie, Klinikum Region Hannover GmbH, Hannover, Germany
| | - Stefan Dazert
- Klinik für HNO-Heilkunde, Kopf- und Hals-Chirurgie, St. Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum, Germany
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Briner HR, Leunig A, Schlegel C, Simmen D. Preoperative risk assessment for ambulatory sinonasal surgery. Eur Arch Otorhinolaryngol 2020; 278:1455-1461. [PMID: 33090277 PMCID: PMC8057978 DOI: 10.1007/s00405-020-06435-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/10/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES An increasing proportion of patients who are candidates for endoscopic sinus surgery can be treated as an outpatient. A preoperative risk assessment is needed to evaluate eligibility for day surgery. This study analyses the effectiveness of a risk assessment scoring system which examines medical, procedure-related, and socioeconomic factors. DESIGN Prospective multicenter study. SETTING Three center study including Klinik Hirslanden, Zurich, Switzerland, Luzerner Kantonsspital, Lucerne, Switzerland and HNO-Klinik München-Bogenhausen, Munich, Germany. PARTICIPANTS Patients with endoscopic sinus procedures between January 1st, 2017 and December 31st, 2018. MAIN OUTCOME MEASURES The "day surgery risk score" consisted of three subgroups with medical, procedure-related and socioeconomic risk factors were assessed to determine if these predicted the severity of postoperative complications. RESULTS Three-hundred and one patients who underwent endoscopic sinus surgery were included. The score resulted in a median value of 5 [5, 5]. In the Receiver-Operating Curve (ROC-the true-positive rate against the false-positive rate), the Area Under the Curve (AUC) was 0.59 with 95% confidence interval from 0.49 to 0.69, indicating that the "day surgery risk score" may be no better at predicting the likelihood of a complication than a random classification model. CONCLUSIONS The "day surgery risk score" is a straightforward risk assessment which combines medical, procedure-related, and socioeconomic factors. The score is easy to use but in trying to decide whether a patient is eligible for ambulatory endoscopic sinus surgery it did not predict whether a complication was more likely to occur.
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Affiliation(s)
- Hans Rudolf Briner
- Center for Otorhinolaryngology, Head and Neck Surgery, Klinik Hirslanden, Witellikerstrasse 40, 8032, Zurich, Switzerland.
| | - Andreas Leunig
- Rhinology Center Munich and ENT-Clinic Dr. Gaertner GmbH, Possartstr. 27-31, 81679, Munich, Germany
| | - Christoph Schlegel
- Department of Otorhinolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, 6000, Lucerne 16, Switzerland
| | - Daniel Simmen
- Center for Otorhinolaryngology, Head and Neck Surgery, Klinik Hirslanden, Witellikerstrasse 40, 8032, Zurich, Switzerland
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Abstract
OBJECTIVES To assess and compare the safety and quality of the management of sinonasal surgery (all procedures) between day-case and traditional admission. MATERIAL AND METHODS A 2-year retrospective study included all patients undergoing functional septonasal surgery, ethmoidectomy, middle antrostomy, frontal sinusotomy or endoscopic sphenoidotomy, as day-surgery on inpatient admission. Demographic, operative, pre- and post-operative anesthetic data, complications, and rates of emergency consultation and readmission within 30 days were collected and compared between out- and in-patients. RESULTS Nine hundred and nine patients were included: 569 functional septonasal surgeries, 180 ethmoidectomies, 101 middle meatotomies, 40 Draf procedures and 19 sphenoidotomies; respectively 60%, 21%, 54%, 20% and 37% were performed in the day-surgery unit. There were no significant differences in number of emergency consultations or readmissions between the out- and in-patient groups. There were more complications in in-patients (P<0.0001) (4.9% anticoagulant and 12% antiplatelet treatments, 18% obstructive sleep apnea-hypopnea syndromes). The conversion rate to conventional admission was 4.6%. Antiplatelet treatment or postoperative nasal packing were not significant risk factors for complications or readmission. CONCLUSION Outpatient sinonasal surgery does not seem to incur extra risk for the patient or surgeon when eligibility criteria are met.
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Balogun JA, Kayode Idowu O, Obanisola Malomo A. Challenging the myth of outpatient craniotomy for brain tumor in a Sub-Saharan African setting: A case series of two patients in Ibadan, Nigeria. Surg Neurol Int 2019; 10:71. [PMID: 31528409 PMCID: PMC6744755 DOI: 10.25259/sni-47-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 01/25/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The concept of modern neuro-oncology hinges on strategic innovation and refinement of procedures with the intention to enhance safety, optimize extent of tumor resection, and improve not only survival but also the quality of life as well. One of such refinements includes same-day hospital admission, as well as early discharge following brain tumor surgeries. The latter has been further stretched to same-day discharge in particular settings to reduce the risk of nosocomial infections, cut brain tumor surgery costs, and improve patients' satisfaction. We highlight the challenges and possible benefits of outpatient craniotomy in a sub-Saharan African setting portrayed by the presence of lean resources and a predominant "out of pocket" health-care financing. CASE DESCRIPTION Outpatient craniotomy was performed in two selected patients harboring intra-axial tumors: a right temporal low-grade glioma and a left frontal metastasis. The clinical outcome proved successful at short- and long-term in both patients; complications related to surgery and same-day discharge were not reported. CONCLUSION Outpatient craniotomy is practicable and safe in resource-challenged environments and can further make brain tumor surgery cost effective and acceptable in carefully selected patients. Further prospective studies in similar settings but involving larger groups of patients are warranted.
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Affiliation(s)
- James Ayokunle Balogun
- Division of Neurosurgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | | | - Adefolarin Obanisola Malomo
- Division of Neurosurgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
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