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Hassan CH, Deberge S, Jegoux F. Outpatient parotidectomy: Outcomes, safety and satisfaction. Am J Otolaryngol 2023; 44:103974. [PMID: 37437335 DOI: 10.1016/j.amjoto.2023.103974] [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] [Received: 05/19/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Parotidectomies are rarely performed on an outpatient basis. The specific perioperative outcomes and their management remains insufficiently described to change daily practice. The objectives were to study the outcomes, the complications and the patient satisfaction rate in parotidectomy performed on an outpatient basis. MATERIALS AND METHODS We conducted a retrospective monocentric database study on 85 patients who underwent parotidectomy as a first and sole procedure from 2015 to 2020. We analyzed perioperative outcomes between outpatients and inpatients. RESULTS Among 28 outpatients and 57 inpatients, no significant differences in total perioperative complications (p = .66; OR = 1.25; 95 % confidence interval (CI) [0.47; 3.36]), reoperations (p = .55), readmissions (p = 1), or unplanned visits (p = .52) were shown in multivariate analysis. The conversion rate for surgical reasons was 8.6 %, and the satisfaction rate was high. CONCLUSION Although outpatient parotidectomies should be as safe as for inpatients, the high rate of minor complications requires specific perioperative management, such as a systematic early postoperative visit and optimized preoperative information in order to be carried out with minimal issues.
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Affiliation(s)
| | - Sarah Deberge
- ENT Surgery, CHU Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes, France
| | - Franck Jegoux
- ENT Surgery, CHU Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes, France
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2
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Talati V, Brown HJ, Losenegger T, Revenaugh P, Al‐Khudari S. Patient safety and quality improvements in parotid surgery. World J Otorhinolaryngol Head Neck Surg 2022; 8:133-138. [PMID: 35782399 PMCID: PMC9242422 DOI: 10.1002/wjo2.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/24/2021] [Indexed: 11/29/2022] Open
Abstract
Parotidectomy is the mainstay treatment for tumors of the parotid gland. In an effort to improve clinical outcomes, several modern surgical techniques and perioperative interventions have been evaluated and refined. This review discusses current and actively debated perioperative interventions aimed at improving patient safety and the quality of parotidectomy. Relevant high-impact literature pertaining to preoperative diagnostic modalities, intraoperative surgical techniques, and postoperative care will be described.
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Affiliation(s)
- Vidit Talati
- Department of Otorhinolaryngology—Head and Neck SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Hannah J. Brown
- Rush Medical CollegeRush University Medical CenterChicagoIllinoisUSA
| | - Tasher Losenegger
- Department of Otorhinolaryngology—Head and Neck SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Peter Revenaugh
- Department of Otorhinolaryngology—Head and Neck SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Samer Al‐Khudari
- Department of Otorhinolaryngology—Head and Neck SurgeryRush University Medical CenterChicagoIllinoisUSA
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3
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Grosheva M, Guntinas-Lichius O, Deitmer T, Klußmann JP. Bedeutung der Wunddrainage und der stationären Behandlung bei Operationen von Speicheldrüsentumoren. Laryngorhinootologie 2022; 101:281-283. [PMID: 35272352 DOI: 10.1055/a-1780-0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Maria Grosheva
- HNO-Uniklinik Köln, Universität zu Köln, Medizinische Fakultät
| | | | - Thomas Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie e. V
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4
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Scher M, Cabrera CI, Cai Y, Tamaki A, Li S, Fowler N, Rezaee R, Lavertu P, Teknos T, Thuener J. Outpatient Parotidectomy, a Safety and Financial Review. Ann Otol Rhinol Laryngol 2021:34894211016714. [PMID: 33980056 DOI: 10.1177/00034894211016714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study is to investigate the safety, efficacy, and potential cost-savings of the outpatient parotidectomy procedure. METHODS This is a retrospective chart review of all patients who underwent a parotidectomy at a large academic center from 2015 through 2019 including demographic data, postoperative complications, drain placement, readmission, and financial cost. A comparison was performed between patients who underwent an outpatient vs inpatient parotidectomy. RESULTS A total of 335 patients underwent parotidectomy (136 outpatient; 199 inpatient). Comparison of patient demographics, common comorbidities, tumor size, tumor type, postoperative complications, and readmission rate was similar between the inpatient and outpatient cohorts. The overall mean cost difference between inpatient parotidectomy and outpatient parotidectomy for all years was $1528.58 (95%CI: $1139-$1916). CONCLUSION The outpatient parotidectomy procedure has a comparable safety profile to the inpatient procedure while providing a significant cost-savings benefit.
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Affiliation(s)
- Maxwell Scher
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Claudia I Cabrera
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Yida Cai
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Akina Tamaki
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Shawn Li
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicole Fowler
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Rod Rezaee
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Pierre Lavertu
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Theodoros Teknos
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jason Thuener
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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5
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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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6
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Lee DJ, Forner D, End C, Yao CMKL, Samargandy S, Monteiro E, Witterick IJ, Freeman JL. Outpatient versus inpatient superficial parotidectomy: clinical and pathological characteristics. J Otolaryngol Head Neck Surg 2021; 50:10. [PMID: 33579392 PMCID: PMC7881444 DOI: 10.1186/s40463-020-00484-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 12/21/2020] [Indexed: 12/26/2022] Open
Abstract
Background Superficial parotidectomy has a potential to be performed as an outpatient procedure. The objective of the study is to evaluate the safety and selection profile of outpatient superficial parotidectomy compared to inpatient parotidectomy. Methods A retrospective review of individuals who underwent superficial parotidectomy between 2006 and 2016 at a tertiary care center was conducted. Primary outcomes included surgical complications, including transient/permanent facial nerve palsy, wound infection, hematoma, seroma, and fistula formation, as well as medical complications in the postoperative period. Secondary outcome measures included unplanned emergency room visits and readmissions within 30 days of operation due to postoperative complications. Results There were 238 patients included (124 in outpatient and 114 in inpatient group). There was no significant difference between the groups in terms of gender, co-morbidities, tumor pathology or tumor size. There was a trend towards longer distance to the hospital from home address (111 Km in inpatient vs. 27 in outpatient, mean difference 83 km [95% CI,- 1 to 162 km], p = 0.053). The overall complication rates were comparable between the groups (24.2% in outpatient group vs. 21.1% in inpatient, p = 0.56). There was no difference in the rate of return to the emergency department (3.5% vs 5.6%, p = 0.433) or readmission within 30 days (0.9% vs 0.8%, p = 0.952). Conclusion Superficial parotidectomy can be performed safely as an outpatient procedure without elevated risk of complications. Graphical abstract ![]()
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Affiliation(s)
- Daniel J Lee
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - David Forner
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.,Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, ON, Canada
| | - Christopher End
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Shireen Samargandy
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology - Head & Neck Surgery, Sinai Health System, 600 University Avenue, Suite 401, Toronto, ON, M5G 1X5, Canada
| | - Ian J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology - Head & Neck Surgery, Sinai Health System, 600 University Avenue, Suite 401, Toronto, ON, M5G 1X5, Canada
| | - Jeremy L Freeman
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada. .,Department of Otolaryngology - Head & Neck Surgery, Sinai Health System, 600 University Avenue, Suite 401, Toronto, ON, M5G 1X5, Canada.
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7
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Edmond M, Campbell E, Reddy V. Day case superficial parotidectomy-does it work? Eur Arch Otorhinolaryngol 2021; 278:4107-4112. [PMID: 33555439 PMCID: PMC7868304 DOI: 10.1007/s00405-021-06642-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To establish if day case superficial parotidectomy is feasible, safe and does not result in excess readmissions. METHOD A retrospective review was carried out of all patients listed for superficial parotidectomy with day case intent by a single surgeon between January 2016 and December 2019 inclusively. The reasons for failure of same day discharge were established. Postoperative complications and readmissions were recorded. Our approach for a superficial parotidectomy typically includes the use of a 10Fr suction drain which is removed at 4 h postoperatively if the output is less than 30 ml. RESULTS Ninety-one consecutive superficial parotidectomies listed for day case surgery were eligible for inclusion. Seventeen patients failed to be discharged on the same day and were admitted giving a day case success rate of 81%. Most of these (n = 9) occurred in the first year of adopting day case surgery. The most common reason to admit patients was a late finish (n = 8, 47%). Six patients (25%) were admitted due to anaesthetic complications. One patient had a surgical complication requiring admission. CONCLUSION Our series demonstrates that day case superficial parotidectomy using a surgical drain is feasible, safe and does not result in an unacceptable readmission rate. In our experience, surgical complications are an uncommon cause for day case failure. The most common cause for day case failure was a late finish. Postoperative complications including bleeding, seroma/salivary collection and facial nerve palsy were in keeping with or better than those quoted in the literature.
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Affiliation(s)
- Mark Edmond
- Poole Hospitals NHS Foundation Trust, Longfleet Road, Poole, Dorset, BH15 2JB, UK. .,ENT Department, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, TR1 3LJ, Cornwall, UK.
| | - Elaine Campbell
- ENT Department, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, TR1 3LJ, Cornwall, UK
| | - Venkat Reddy
- ENT Department, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, TR1 3LJ, Cornwall, UK
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8
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Benito DA, Pasick LJ, Bestourous D, Thakkar P, Goodman JF, Joshi AS. Outpatient vs inpatient parotidectomy: Systematic review and m
eta‐analysis. Head Neck 2020; 43:668-678. [DOI: 10.1002/hed.26482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/11/2020] [Accepted: 09/21/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Daniel A. Benito
- Division of Otolaryngology – Head and Neck Surgery George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Luke J. Pasick
- Department of Otolaryngology – Head and Neck Surgery University of Miami Miller School of Medicine Miami Florida USA
| | - Daniel Bestourous
- Division of Otolaryngology – Head and Neck Surgery George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Punam Thakkar
- Division of Otolaryngology – Head and Neck Surgery George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Joseph F. Goodman
- Division of Otolaryngology – Head and Neck Surgery George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Arjun S. Joshi
- Division of Otolaryngology – Head and Neck Surgery George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
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9
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Lambiel S, Dulguerov N, Courvoisier DS, Dulguerov P. Minor Parotidectomy Complications: A Systematic Review. Laryngoscope 2020; 131:571-579. [PMID: 32678921 DOI: 10.1002/lary.28912] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To report descriptive statistics for minor parotidectomy complications. METHODS A systematic review was performed, selecting 235 studies for analysis. The incidence of complications was tabulated, and descriptive statistics calculated. Outlier studies, 1 standard deviation above the mean, were reexamined to determine potential causal factors for each complication. All studies were examined for statistically significant differences for any potential causal factor. RESULTS The pooled incidence of minor complications reported were hematoma 2.9% (95% confidence interval [CI]: 2.4-3.5), wound infection 2.3% (95% CI: 1.8-2.9), sialocele 4.5% (95% CI: 3.5-5.7), salivary fistula 3.1% (95% CI: 2.6-3.7), flap necrosis 1.7% (95% CI: 1.1-2.5), scar issues 3.6% (95% CI: 2.4-5.4), numbness 33.9% (95% CI: 25.6-43.4), and deformity 11.8 (95% CI: 6.9-19.5). Implants result in more wound complications, such as hematoma, sialocele, or salivary fistula. Sialocele and salivary fistula appear more frequently after less extensive parotid surgery, whereas hematoma, wound infections, flap necrosis, and aesthetic considerations are worse with more extensive resections. CONCLUSIONS Minor parotidectomy complications are more frequent than generally assumed and related to certain factors that should be investigated. Laryngoscope, 131:571-579, 2021.
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Affiliation(s)
- Silvia Lambiel
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Nicolas Dulguerov
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | | | - Pavel Dulguerov
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland.,Center for Otorhinolaryngology-Maxillofacial and Head and Neck Surgery, La Tour Hospital, La Tour Medical Group, Meyrin, Switzerland
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Michel MC, Mulcahy CF, Benito DA, Patel S, Badger C, Kane S, Li NW, Goodman JF, Thakkar PG, Joshi AS. Outpatient Parotidectomy: A Retrospective Series. Ann Otol Rhinol Laryngol 2020; 130:254-261. [PMID: 32672069 DOI: 10.1177/0003489420938101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Recent literature suggests that outpatient head and neck surgery is safe and may decrease costs. This study assesses whether outpatient parotidectomy differs in complication type and rate from inpatient surgery. METHODS Patients who underwent parotidectomy at our institution from 2011 to 2019 were retrospectively reviewed and divided by inpatient or outpatient status. Complications including infection, seroma, salivary fistula, hematoma, and flap necrosis, as well as readmission rates were tabulated. Drain placement, related to tumor size, was also analyzed using a receiver operating curve. RESULTS 144 patients had available data for analysis. Nine of the 144 patients had complications. Seven of 98 outpatients and two of 46 inpatients had complications. There was no statistically significant difference in complication rate between the two groups (P = .518). Tumor size ≥4.62 cm3 was associated with drain placement (P = .044). CONCLUSION Outpatient parotidectomy is a safe and viable alternative for carefully selected patients.
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Affiliation(s)
- Margaret C Michel
- Division of Otolaryngology-Head & Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Collin F Mulcahy
- Division of Otolaryngology-Head & Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Daniel A Benito
- Division of Otolaryngology-Head & Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Sahil Patel
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Christopher Badger
- Division of Otolaryngology-Head & Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Sean Kane
- Division of Otolaryngology-Head & Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Ning-Wei Li
- Division of Otolaryngology-Head & Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Joseph F Goodman
- Division of Otolaryngology-Head & Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Punam G Thakkar
- Division of Otolaryngology-Head & Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Arjun S Joshi
- Division of Otolaryngology-Head & Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
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Grosheva M, Klußmann JP, Beutner D, Formanek M, Lill C, Laskawi R, Zenk J, Pick C, Erlacher B, Bemmer J, Thielker J, Jering M, Tostmann R, Guntinas-Lichius O. [Planning and design of European prospective randomized trial on the value of drain in parotidectomy]. Laryngorhinootologie 2020; 100:46-53. [PMID: 32516811 DOI: 10.1055/a-1178-0800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION There are no valid clinical studies on the value of wound drains in parotid surgery. The aim of the current trial is to analyze the influence of the closed wound drain (redon) on the incidence of postoperative complications such as bleeding, wound healing problems, infection, as well as salivary cyst and fistula after superficial or partial parotidectomy. METHODS A European-wide multicenter prospective randomized study was planned. The study protocol was prepared by the leading study center (ENT University Hospital Cologne) in cooperation with the ENT University Hospitals Jena and Göttingen. The calculation of the number of cases was carried out with G*Power. The study includes test persons with an indication for parotidectomy for a benign tumor without known coagulation disorder or ongoing anticoagulation. Preoperative randomization and data management is software-supported (REDCap 9.1.24, Vanderbilt University). RESULTS The study has been approved by the leading ethics committee in 10/2019 and is open since 04/2019. Currently, nine (9) ENT hospitals are participating in the study, 6 of them in Germany and 3 in Austria. Enrollment of patients is ongoing in 7 centers. With a calculated follow-up-to-treat population of 800 test persons, the planned duration of the study is 4 years. CONCLUSIONS The Redon-study is the first prospective randomized study worldwide to investigate the effect of a drain in parotidectomy. In order to achieve the recruitment goal within the planned time frame, the participation of further specialized study centers is needed. We also encourage all ENT physicians to make their patients aware of the Redon study, inform them about the possibility of participating in the study and refer them to one of the participating centers.
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Affiliation(s)
- Maria Grosheva
- HNO Uniklinik Köln, Medizinische Fakultät, University of Cologne, Köln, Germany
| | - Jens Peter Klußmann
- HNO Uniklinik Köln, Medizinische Fakultät, University of Cologne, Köln, Germany
| | - Dirk Beutner
- Klinik für Hals-Nasen-Ohrenheilkunde, Georg-August-Universität Göttingen, Germany
| | - Michael Formanek
- HNO und Phoniatrie, Krankenhaus der Barmherzigen Brüder, Wien, Austria
| | - Claudia Lill
- Institut für Kopf- und Halserkrankungen, Evangelisches Krankenhaus Wien, Austria
| | - Rainer Laskawi
- Klinik für Hals-Nasen-Ohrenheilkunde, Georg-August-Universität Göttingen, Germany
| | - Johannes Zenk
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Augsburg, Germany
| | - Carina Pick
- HNO Uniklinik Köln, Medizinische Fakultät, University of Cologne, Köln, Germany
| | - Birgit Erlacher
- HNO und Phoniatrie, Krankenhaus der Barmherzigen Brüder, Wien, Austria
| | - Julian Bemmer
- Klinik für Hals-Nasen-Ohrenheilkunde, Georg-August-Universität Göttingen, Germany
| | - Jovanna Thielker
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Germany
| | - Monika Jering
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Augsburg, Germany
| | - Ralf Tostmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Georg-August-Universität Göttingen, Germany
| | - Orlando Guntinas-Lichius
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Jena, Germany
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12
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Forner D, Lee DJ, Walsh C, Witterick IJ, Taylor SM, Freeman J. Outpatient versus Inpatient Parotidectomy: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 162:818-825. [PMID: 32286187 DOI: 10.1177/0194599820911725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Parotidectomies are commonly performed procedures by head and neck surgeons. Although parotidectomies are historically inpatient procedures, recent observational evidence has highlighted the potential for parotidectomies to be performed on an outpatient basis. This systematic review and meta-analysis sought to compare complications and unplanned health care utilization between patients undergoing outpatient versus inpatient parotidectomy. DATA SOURCES A systematic review was performed using MEDLINE, EMBASE, and the Cochrane Library. REVIEW METHODS Studies comparing the outcomes of outpatient parotidectomy with those of inpatient parotidectomy were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. Postoperative complications (hematoma, facial nerve dysfunction, seroma, fistulisation, Frey syndrome, and wound infection) and rates of 30-day readmission, reintervention, and emergency department presentation were compared. RESULTS We screened 1018 nonduplicate articles to include 5 studies, all of which were retrospective cohort studies. There were fewer complications found in the outpatient group (relative risk = 0.61, 95% confidence interval: 0.40-0.93). Outpatient procedures were more commonly performed on patients who lived close to the hospital, had fewer comorbidities, and had less extensive planned surgery. CONCLUSION Outpatient parotidectomy appears safe in select patients with outcomes comparable with inpatient surgery. However, evidence overall is of low quality, and further work is needed to delineate a satisfactory set of criteria for appropriate patient identification.
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Affiliation(s)
- David Forner
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Ontario, Canada
| | - Daniel J Lee
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Chris Walsh
- Sidney Liswood Health Sciences Library, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - S Mark Taylor
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Ontario, Canada
| | - Jeremy Freeman
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Flach S, Hey SY, Lim A, Maniam P, Li Z, Donnan PT, Manickavasagam J. Outpatient (same‐day discharge) versus inpatient parotidectomy: A systematic review and meta‐analysis. Clin Otolaryngol 2020; 45:529-537. [DOI: 10.1111/coa.13519] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/13/2019] [Accepted: 01/15/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Susanne Flach
- Department of Otorhinolaryngology and Head & Neck Surgery Hospital of the Ludwig‐Maximilians‐University Munich Germany
| | - Shi Ying Hey
- Department of Otorhinolaryngology and Head & Neck Surgery Ninewells Hospital Dundee UK
| | - Alison Lim
- Department of Otorhinolaryngology and Head & Neck Surgery Ninewells Hospital Dundee UK
| | | | - Zhi Li
- Dundee Epidemiology and Biostatistics Unit (DEBU) Population Health Sciences (PHS) The Medical School University of Dundee Dundee UK
| | - Peter T. Donnan
- Dundee Epidemiology and Biostatistics Unit (DEBU) Population Health Sciences (PHS) The Medical School University of Dundee Dundee UK
| | - Jaiganesh Manickavasagam
- Department of Otorhinolaryngology and Head & Neck Surgery Ninewells Hospital Dundee UK
- Tayside Medical Science Centre (TASC) University of Dundee Dundee UK
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The effect of fibrin sealant tissue glue in reducing post-operative collections following parotidectomy. Eur Arch Otorhinolaryngol 2020; 277:2055-2059. [DOI: 10.1007/s00405-020-05903-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/02/2020] [Indexed: 12/28/2022]
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Khafif A, Niddal A, Azoulay O, Holostenco V, Masalha M. Parotidectomy via Individualized Mini-Blair Incision. ORL J Otorhinolaryngol Relat Spec 2020; 82:121-129. [PMID: 32097928 DOI: 10.1159/000505192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/28/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The modified Blair incision is the standard facial incision for the vast majority of parotid gland lesions. We utilize three types of incisions: "classic mini-Blair" for parotid body tumors, "cervical mini-Blair" for parotid tail tumors, and "vertical mini-Blair" for anterior parotid tumors. In this study, we describe the surgical and esthetic outcomes of these individually tailored incisions. METHODS Patients undergoing parotidectomy between 2011 and 2013 were included. The surgical outcomes and patients' satisfaction were assessed. RESULTS Of 122 patients, 89 were included. All patients completed a questionnaire assessing the postoperative course and patients' satisfaction regarding the surgery in general and the scar in particular. Among these patients, 78 (87%) had a benign pathology and 11 (13%) had malignant tumors. The tumors were located at the parotid body in 57 patients (64%), at the parotid tail in 19 (21%), at the deep lobe in 8 (9%), and at the anterior parotid gland in 5 (6%). All tumors were removed successfully with negative margins on pathology. No inadvertent permanent facial nerve paralysis occurred. The median operation time was 72 min (23-211). The average patient scores of satisfaction with the surgical scar and with the surgery were 9.54 and 9.72, respectively. CONCLUSIONS Individualized mini-Blair incision is feasible for benign as well as selected malignant parotid tumors.
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Affiliation(s)
- Avi Khafif
- Department of Otolaryngology - Head and Neck Surgery, Assuta Medical Center, Ben Gurion University in Beer Sheva, Tel Aviv, Israel
| | - Assadi Niddal
- Department of Otolaryngology - Head and Neck Surgery, Assuta Medical Center, Ben Gurion University in Beer Sheva, Tel Aviv, Israel
| | - Ofer Azoulay
- Department of Otolaryngology - Head and Neck Surgery, Assuta Medical Center, Ben Gurion University in Beer Sheva, Tel Aviv, Israel
| | - Victoria Holostenco
- Department of Otolaryngology - Head and Neck Surgery, Assuta Medical Center, Ben Gurion University in Beer Sheva, Tel Aviv, Israel
| | - Muhamed Masalha
- Department of Otolaryngology - Head and Neck Surgery, Assuta Medical Center, Ben Gurion University in Beer Sheva, Tel Aviv, Israel, .,Department of Otolaryngology - Head and Neck Surgery, Emeq Medical Center, Technion University in Haifa, Afula, Israel,
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