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Lenze NR, Garcia J, Vijayakumar P, Schütz SG, Brenner MJ, Stanley JJ, Hoff PT. Implementing a Streamlined Hypoglossal Nerve Stimulator Pathway: Cost, Time to Surgery, and Outcomes. OTO Open 2024; 8:e70007. [PMID: 39364004 PMCID: PMC11447855 DOI: 10.1002/oto2.70007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 08/21/2024] [Indexed: 10/05/2024] Open
Abstract
Objective To evaluate the costs, time to surgery, and clinical outcomes associated with implementing a streamlined hypoglossal nerve stimulator (HGNS) implantation pathway. Study Design Retrospective cohort study. Setting Single tertiary care center in the United States from 2016 to 2023. Methods Patients with a lack of complete concentric collapse of the velum during volitional snore on in-office laryngoscopy qualified for the streamlined HGNS pathway. This pathway consisted of confirmatory drug-induced sleep endoscopy (DISE) followed immediately by HGNS implantation during the same surgical encounter. Outcomes were compared to patients in the traditional pathway (standalone DISE followed by HGNS implantation on a later date). Results A total of 68 patients (13 streamlined, 55 traditional) with obstructive sleep apnea who underwent HGNS implantation were included. Patients were predominately male (70.6%) and White (95.6%) and had a mean (SD) age of 63.5 (10.0) years. The streamlined pathway was associated with a significant reduction in both hospital costs (mean difference $9258, 95% confidence interval [CI]: 3690-14,825; P = .002) and time to surgery (mean decrease of 3.82 months, 95% CI: 0.83-6.80 months; P = .013) compared to the traditional pathway. Patients in both groups had reduction in apnea-hypopnea index and Epworth Sleepiness Scale score, with no significant differences in comparisons between groups. Conclusion In select patients, the streamlined HGNS pathway may expedite time to surgery and reduce hospital costs with comparable clinical outcomes to a traditional 2-stage pathway. Further research is warranted to validate patient selection and better understand longitudinal outcomes.
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Affiliation(s)
- Nicholas R. Lenze
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Jayden Garcia
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Punithavathy Vijayakumar
- Department of Neurology, Sleep Disorders CenterUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Sonja G. Schütz
- Department of Neurology, Sleep Disorders CenterUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Michael J. Brenner
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Jeffrey J. Stanley
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Paul T. Hoff
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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Foppiani JA, Kim E, Weidman A, Valentine L, Stearns S, Alvarez AH, Lee TC, Moradian S, Lee BT, Lin SJ. Preferences and Barriers of Male Patients Seeking Aesthetic Procedures. Aesthetic Plast Surg 2024; 48:1465-1472. [PMID: 37750951 DOI: 10.1007/s00266-023-03659-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/06/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND As social attitudes toward plastic surgery continue to evolve, the prevalence of men seeking plastic surgery has been increasing. By delving into the factors that encourage male patients to seek plastic surgery and the obstacles they encounter, this study aims to facilitate the development of more inclusive and effective approaches for this population. METHOD An anonymous 41-question survey was conducted among adult men in the USA via the Amazon Mechanical Turk crowdsourcing platform. Questions assessed demographic information and identified factors that influenced males to seek plastic surgery care, the barriers they experienced while seeking care, and their preferences. Multivariate logistic regression was used to assess relationships between demographic variables and likelihood of undergoing cosmetic surgery. RESULTS Four hundred and eleven complete responses were analyzed. The median (IQR) age of respondents was 32 (30, 40) years old. Of the respondents, 60% had undergone cosmetic surgery. Functional improvement (40%), personal aspiration (32%), and partners' opinions (22%) were the most commonly cited reasons for undergoing procedures. The most common barriers faced by this population were recovery time following a procedure (52%), perceived risk of complications (48%), cost (43%), fear of being identified as having had plastic surgery (32%), and surgeons not being able to meet expectations (31%). Eighty-nine percent of respondents who underwent plastic surgery procedures reported facing at least one barrier. Multivariate regression demonstrated that higher education levels were strongly associated with a likelihood of undergoing cosmetic surgery (p < 0.001). Income (p = 0.44) and region (p = 0.23) did not significantly affect the likelihood of undergoing plastic surgery. CONCLUSION Despite improving societal stigma, many male patients continue to face barriers when obtaining plastic surgery care. Efforts may be made to alleviate these barriers and surgeons looking to expand their practice may benefit from increased outreach to male patients. This may be compounded with improved education targeting stigma and risks of procedures, increasing male-specific marketing communications to make them feel welcome in an industry predominantly focused on female patients, and offering male-tailored procedures. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Jose A Foppiani
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
| | - Erin Kim
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
| | - Allan Weidman
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
| | - Lauren Valentine
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
| | - Stephen Stearns
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
| | - Angelica Hernandez Alvarez
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
| | | | - Simon Moradian
- Division of Plastic Surgery, Northwestern Medicine, Feinberg School of Medicine, Chicago, IL, USA
| | - Bernard T Lee
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
| | - Samuel J Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA.
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Torbjörnsson E, Fagerdahl AM, Älgå A. Experiences of Acute Surgical Care During the Coronavirus Disease 2019 Pandemic Among Patients and Their Next of Kin. J Surg Res 2022; 277:163-170. [PMID: 35490605 PMCID: PMC9005363 DOI: 10.1016/j.jss.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/10/2022] [Accepted: 04/05/2022] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Since March 2020, the coronavirus disease 2019 pandemic has affected healthcare systems worldwide. It is largely unknown how acutely ill surgical patients and their next of kin have perceived the hospital care during the ongoing pandemic. Therefore, we aimed to explore their experiences. MATERIAL AND METHODS We performed 12 interviews with patients who had undergone acute abdominal surgery in a public acute care hospital in Sweden during March to June 2020. In addition, we interviewed 10 of the patients' next of kin. We analyzed the interviews using content analysis. RESULTS Our analysis resulted in two themes: "Worries about seeking acute care" and "The surgical care worked adequately, even though the system was overloaded." The participants experienced that the hospital maintained its functionality during the ongoing pandemic. Both the patients and their next of kin experienced insufficient information by the hospital, especially during the initial acute phase and at discharge, which led to a perceived loss of control. The implemented ban on visitors was found to have had both positive and negative effects for the patients, whereas the next of kin's experiences focused on the difficulties with not being able to visit. CONCLUSIONS Our findings indicate that the challenges of communication with patients and their next of kin are exacerbated during a crisis such as a pandemic. In addition, a ban on visitors might have both positive and negative aspects. Therefore, we propose individualized routines for visits to acute surgical patients when possible.
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Affiliation(s)
- Eva Torbjörnsson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Department of Surgery, Södersjukhuset, Stockholm, Sweden,Corresponding author. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden. Tel.: +46 733 544 335; fax: + 46 8 616 2460
| | - Ann-Mari Fagerdahl
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Wound Centre, Södersjukhuset, Stockholm, Sweden
| | - Andreas Älgå
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Department of Surgery, Södersjukhuset, Stockholm, Sweden
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Kourelis K, Angelopoulou M, Goulioumis A, Fouzas S, Kourelis T. Surgery for adenotonsillar hypertrophy and otitis media in children is less demanded in quarantine times. Int J Pediatr Otorhinolaryngol 2022; 158:111169. [PMID: 35552162 DOI: 10.1016/j.ijporl.2022.111169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/21/2022] [Accepted: 04/30/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In the COVID-19 era, extreme measures of social distancing have contained the spread of common viral respiratory infections, which are involved in the pathogenesis of Adenotonsillar Hypertrophy (ATH), and Chronic Otitis Media with Effusion (COME), the two commonest chronic ENT diseases of childhood. This study examines the lockdown effect on the number of procedures performed for these two conditions. METHODS The consecutive charts of 650 and 195 children being operated respectively for ATH and COME during the quarantine (05/2020-02/2021) and unrestrained (05/2019-02/2020) periods were retrospectively reviewed. Surgical treatment of ankyloglossia, performed in 103 patients during the same periods was employed as a control procedure. RESULTS Adenotonsillectomies and tympanostomies significantly decreased in the lockdown phase by 52% (P < 0.001) and 74% (P < 0.001), respectively, whereas control procedure counts increased by 25%. In terms of seasonal variation, ATH-related surgeries were significantly reduced during the winter season of the pandemic by 73% (P < 0.001), in comparison with the corresponding months of the unrestrained period. School-aged children received significantly fewer operations for ATH (-59%) than preschoolers (-42%), as a result of the lockdown (P = 0.044). CONCLUSION When the child's exposure to respiratory pathogens is minimal, as in the case of lockdown, a noticeable decline occurs in the incidence of ATH and COME indicated for surgical treatment. Chronic low-grade inflammation, boosted by repetitive viral infections seems to underlie both conditions. Timely, effective isolation measures might reverse the disease process and keep the child away from the Operating Room.
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Affiliation(s)
- Konstantinos Kourelis
- Department of Otolaryngology, Children's Hospital of Patras "Karamandaneio", 26331, Patras, Greece.
| | - Maria Angelopoulou
- Department of Otolaryngology, Children's Hospital of Patras "Karamandaneio", 26331, Patras, Greece
| | - Anastasios Goulioumis
- Department of Otolaryngology, Children's Hospital of Patras "Karamandaneio", 26331, Patras, Greece
| | - Sotirios Fouzas
- Department of Pediatrics, University Hospital of Patras, 26504, Patras, Greece
| | - Theodoros Kourelis
- Department of Medical Oncology, "Olympian" General Hospital, 26443, Patras, Greece
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