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Lenkeit CP, Fritz CG, Choi JS, Schutt CA, Hong RS, Babu SC, Bojrab DI. Quantifying the effect of shoulder size on operation duration: an analysis of stapes surgery outcomes. J Laryngol Otol 2024; 138:258-264. [PMID: 37203445 DOI: 10.1017/s0022215123000890] [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: 05/20/2023]
Abstract
OBJECTIVE To investigate the effect of body mass index on hearing outcomes, operative time and complication rates following stapes surgery. METHOD This is a five-year retrospective review of 402 charts from a single tertiary otology referral centre from 2015 to 2020. RESULTS When the patient's shoulder was adjacent to the surgeon's dominant hand, the average operative time of 40 minutes increased to 70 minutes because of a significant positive association between higher body mass index and longer operative times (normal body mass index group (<25 kg/m2) r = 0.273, p = 0.032; overweight body mass index group (25-30 kg/m2) r = 0.265, p = 0.019). Operative times were not significantly longer upon comparison of low and high body mass index groups without stratification by laterality (54.9 ± 19.6 minutes vs 57.8 ± 19.2 minutes, p = 0.127). CONCLUSION There is a clinically significant relationship between body mass index and operating times. This may be due to access limitations imposed by shoulder size.
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Affiliation(s)
- Christopher P Lenkeit
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Department of Otolaryngology - Head and Neck Surgery, McLaren Oakland, Pontiac, Michigan, USA
| | - Christian G Fritz
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Christopher A Schutt
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Neurotology Division, St John Providence Health System, Novi, Michigan, USA
- Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Robert S Hong
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Neurotology Division, St John Providence Health System, Novi, Michigan, USA
- Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA
| | - Seilesh C Babu
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Neurotology Division, St John Providence Health System, Novi, Michigan, USA
- Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA
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Predictive Patient Factors for Poor Outcomes Following Stapedotomy for Otosclerosis. Otol Neurotol 2022; 43:619-624. [PMID: 35283465 DOI: 10.1097/mao.0000000000003522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess patient-related risk factors associated with poor outcomes following stapedotomy for otosclerosis. STUDY DESIGN Retrospective study. SETTING Academic tertiary care center. METHODS Retrospective chart review of 107 patients with otosclerosis who underwent stapedotomy between 2013 and 2020. Demographics, comorbidities, and smoking history were obtained. Preoperative and postoperative audiogram data, including air-bone gap (ABG), and complications were collected. Data were analyzed using t test and Fischer's exact test for continuous and categorical variables, respectively. RESULTS Among 107 patients, 29.5% were smokers and 70.1% non-smokers. Overall, the average ABG-gain 3-months postoperatively was 20.2 dB, and intraoperative and postoperative complications were 3.74 and 13.1%, respectively. Those with a history of otologic procedures had a lower mean ABG gain at 3 months compared with those without previous otologic surgery (14.4 dB versus 20.4 dB, p = 0.018). The average ABG gain at 3-months was not significantly different between those with current, former, or no smoking history, respectively (13.5 versus 18.1 versus 20.6, p = 0.08). Current smokers had 4.5 times greater odds of complications compared with non-smokers, although not statistically significant (95% CI 0.9-22.8, p = 0.1912). CONCLUSION Age and history of otologic procedures as independent risk factors did impact hearing outcomes among our patient cohort; however, smoking history did not. Future prospective studies are required to further investigate complication rates by various modifiable risk factors, such as smoking status, body mass index (BMI), and obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) use, for stapedotomy surgeries.
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Wardlow RD, Bernstein IA, Orlov CP, Rowan NR. Implications of Obesity on Endoscopic Sinus Surgery Postoperative Complications: An Analysis of the NSQIP Database. Otolaryngol Head Neck Surg 2020; 164:675-682. [DOI: 10.1177/0194599820955180] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective To evaluate the influence of body mass index on postoperative adverse events in adult patients undergoing endoscopic sinus surgery. Study Design Retrospective cohort study. Setting Database of the American College of Surgeons NSQIP (National Surgical Quality Improvement Program) from 2006 to 2018. Methods The NSQIP database was queried for adult patients undergoing endoscopic sinus surgery. The total sample (N = 1546) was stratified by nonobese (18.5 kg/m2≤ body mass index <30 kg/m2) and obese (≥30 kg/m2). Demographics, comorbidities, intraoperative variables, and postoperative adverse events were compared via chi-square analysis and multivariable logistic regression. Results Obese patients accounted for 49.7% (n = 768) of the cohort. Obese patients had a higher American Society of Anesthesiologists classification (class III, 45.1% vs 29.5%; P < .001), rate of diabetes (18.2% vs 7.2%, P < .001), and rate of hypertension requiring medication (43.1% vs 23.0%, P < .001). Nonobese patients were more likely to be >58 years of age (23.4% vs 29.0%, P = .02) and have disseminated cancer (<1% vs 3.2%, P < .001). The obese cohort had a lower frequency of surgical complications (3.0% vs 5.4%, P = .027), driven by frequency of perioperative bleeding (1.8% vs 3.7%, P = .022). There was no statistical difference in medical complications ( P = .775), unplanned readmissions ( P = .286), unplanned reoperations ( P = .053), or 30-day mortality ( P > .999). After multivariable adjustment, obese subjects had decreased odds of any surgical complication (adjusted odds ratio [aOR], 0.567; 95% CI, 0.329-0.979), perioperative bleeding (aOR, 0.474; 95% CI, 0.239-0.942), and any adverse postoperative event (aOR, 0.740; 95% CI, 0.566-0.968). Conclusion Obesity does not increase the risk of 30-day adverse outcomes following endoscopic sinus surgery and may even be protective against perioperative bleeding.
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Affiliation(s)
- Robert D. Wardlow
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Isaac A. Bernstein
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Cinthia P. Orlov
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Nicholas R. Rowan
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
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Kay-Rivest E, Mascarella M, Sewitch MJ, Cloutier F, Mijovic T. Association between Smoking and 30-Day Outcomes in Otologic Surgery. Otolaryngol Head Neck Surg 2019; 162:108-113. [DOI: 10.1177/0194599819889622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ObjectiveTo determine the effect of current smoking status on 30-day postoperative adverse events in patients undergoing otologic surgery.Study DesignRetrospective cohort study.SettingDatabase of the American College of Surgeons National Surgical Quality Improvement Program from 2006 to 2016.Subjects and MethodsAdult patients undergoing middle ear and mastoid surgery were included. Preoperative smoking status was determined, and adverse events within 30 days of surgery were recorded. Descriptive statistics were used to characterize the study sample. Multivariable logistic regression was performed to identify the association between sociodemographic and clinical variables and postoperative adverse events. Population-attributable fractions were then calculated.ResultsA total of 10,684 patients who underwent otologic surgery were included, of whom 2036 (19.1%) were smokers. The most commonly performed surgery was tympanoplasty with and without ossicular chain reconstruction, followed by canal wall up tympanomastoidectomy. Adverse events occurred in 221 (2.1%) patients; the most common was superficial wound infections (n = 99, 0.9%). In smokers, the odds ratio for any adverse event was 1.97 (95% CI, 1.42-2.71). The odds ratios (95% CIs) for superficial wound infections, wound dehiscence, and 30-day readmission among smokers were 1.89 (1.32-2.86), 3.92 (1.26-11.60), and 1.84 (1.15-2.87), respectively. The population-attributable fraction for any adverse event in smokers was 15.5%.ConclusionsIn patients undergoing otologic surgery, smokers are more likely than nonsmokers to have postoperative adverse events—in particular, wound infections, wound dehiscence, and readmission to hospital.
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Affiliation(s)
- Emily Kay-Rivest
- Department of Otolaryngology–Head and Neck Surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Marco Mascarella
- Department of Otolaryngology–Head and Neck Surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
- Departments of Medicine, Epidemiology, Biostatistics and Occupational Health, and Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Maida J. Sewitch
- Departments of Medicine, Epidemiology, Biostatistics and Occupational Health, and Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - François Cloutier
- Department of Otolaryngology–Head and Neck Surgery, Pierre Boucher Hospital, Longueil, Quebec, Canada
| | - Tamara Mijovic
- Department of Otolaryngology–Head and Neck Surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
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Abstract
BACKGROUND Increased body mass index (BMI) has been associated with postoperative complications in multiple surgical specialties. In otologic surgery involving the stapes, where appropriate patient positioning and surgical dexterity are necessary for proper prosthesis placement, patients with higher BMI could make surgery more challenging. The purpose of this study is to evaluate the impact of BMI on outcomes after stapes surgery. METHODS Medical records were examined from January 2015 to December 2017 in patients undergoing stapedectomy or stapedotomy at two tertiary care facilities. A retrospective cohort analysis comparing hearing outcomes on postoperative audiogram following procedural intervention with BMI was performed. The primary outcome was postoperative air-bone gap (dB) on audiogram. RESULTS Two hundred sixty three stapedotomy and stapedectomy patients were included in the study. Six percent had BMI less than 18.5 (underweight), 30% had BMI between 18.6 and 24.9 (normal weight), 38% had BMI between 25 and 29.9 (overweight), 24% had BMI above 30 (obese). The mean preoperative and postoperative air-bone gap (ABG) was 27.0 dB (standard deviation [SD] 15) and 10.4 dB (SD 10.6), respectively, with a postoperative ABG less than or equal to 20 dB in 87% of cases. There were no significant differences in postoperative ABG results when comparing the BMI categories (p = 0.11). CONCLUSIONS Stapedotomy and stapedectomy are effective surgeries that can be performed by experienced surgeons with successful hearing improvement. While high BMI patients may be a challenge to position appropriately for their surgery, this does not translate to altered otologic outcomes for these patients.
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