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Céruse P, Vergez S, Marie JP, Baujat B, Jegoux F, Malard O, Albert S, Badet L, Blanc J, Deneuve S, Faure F, Fuchsmann C, Morelon E, Philouze P. Laryngeal graft after total laryngectomy in humans: A SWiM analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:81-85. [PMID: 38135563 DOI: 10.1016/j.anorl.2023.12.001] [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: 12/24/2023]
Abstract
Evaluation of the results of laryngeal transplantation (LT) in humans. Analysis of 3 bibliographic databases with the keywords "larynx, transplantation, autograft". In total, 626 abstracts were read and 25 articles selected. The main objective was to analyze the characteristics of laryngeal transplant patients. The accessory objectives comprised analysis of operative technique, immunosuppressive treatment and results. Four articles were selected for analysis. Two patients were transplanted after total laryngectomy for laryngeal carcinoma and 2 after laryngeal trauma. Three of the 4 patients had true transplantation with arterial, venous and neural microanastomosis. Two patients were decannulated and the tracheostomy tube was maintained in the other 2. Three of the 4 patients had good-quality phonation and could feed without a gastric tube. One patient died of carcinoma progression and 1 patient had to be explanted 14 years after transplantation. The number of LTs reported is too small for scientific determination of the place of this intervention in laryngology. The published results could, at first sight, suggest that the future of LT is uncertain. However, several elements, also suggest that otolaryngologists should continue to take an interest in this technique.
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Affiliation(s)
- P Céruse
- Centre Hospitalo-Universitaire Lyon Nord, Hospices Civils de Lyon, Lyon, France.
| | - S Vergez
- Centre Hospitalo-Universitaire de Toulouse, Hôpital Larrey, Toulouse, France
| | - J-P Marie
- Centre Hospitalo-Universitaire de Rouen, Rouen, France
| | - B Baujat
- Centre Hospitalo-Universitaire de Tenon, Paris, France
| | - F Jegoux
- Centre Hospitalo-Universitaire de Rennes, Rennes, France
| | - O Malard
- Centre Hospitalo-Universitaire de Nantes, Nantes, France
| | - S Albert
- Groupe Hospitalier Ambroise-Paré, Paris, France
| | | | - J Blanc
- Centre Hospitalo-Universitaire Lyon Nord, Hospices Civils de Lyon, Lyon, France
| | - S Deneuve
- Centre Hospitalo-Universitaire de Rouen, Rouen, France
| | - F Faure
- Centre Hospitalo-Universitaire Lyon Nord, Hospices Civils de Lyon, Lyon, France
| | - C Fuchsmann
- Centre Hospitalo-Universitaire Lyon Nord, Hospices Civils de Lyon, Lyon, France
| | | | - P Philouze
- Centre Hospitalo-Universitaire Lyon Nord, Hospices Civils de Lyon, Lyon, France
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2
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Sánchez-Gómez S, Molina-Fernández E, Acosta Mosquera ME, Palacios-García JM, López-Álvarez F, Juana Morrondo MSD, Tena-García B. Tracheotomy versus tracheostomy, the need for lexicographical clarification. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024; 75:73-82. [PMID: 38224867 DOI: 10.1016/j.otoeng.2023.06.011] [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: 04/27/2023] [Accepted: 06/25/2023] [Indexed: 01/17/2024]
Abstract
In the healthcare field, the terms "traqueotomía" and "traqueostomía" are frequently used, often leading to confusion among professionals regarding the appropriate definition for each term or which one should be considered more correct in specific cases. A search was conducted for the terms "traqueotomía" and "traqueostomía" in general Spanish-language dictionaries such as the Dictionary of the Royal Spanish Academy (DRAE) and the Historical Dictionary of the Spanish Language of the Royal Spanish Academy (DHLE), as well as for the English terms "tracheotomy" and "tracheostomy" in English general dictionaries like the Oxford Dictionary, the Cambridge Dictionary, and the Collins English Dictionary. Additionally, searches were performed in medical dictionaries in both Spanish, specifically the Dictionary of Medical Terms of the National Academy of Medicine (DTM), and English, including the Farlex Dictionary. The terms were also explored using the Google search engine. Definitions were analyzed from both lexicographical and etymological perspectives. Definitions found in general dictionaries, in both Spanish and English, were found to be imprecise, limited, and ambiguous, as they mixed outdated indications with criteria that deviated from etymology. In contrast, definitions in medical dictionaries in both languages were more aligned with etymology. "Traqueotomía" strictly identifies the surgical procedure of creating an opening in the anterior face of the trachea. "Traqueostomía" identifies the creation of an opening that connects the trachea to the exterior, involving a modification of the upper airway by providing an additional entry for the respiratory pathway. "Traqueostomía" becomes the sole means of entry to the airway in total laryngectomies. Both terms can be used synonymously when a traqueotomía culminates in a traqueostomía. However, it is not appropriate to use the term "traqueostomía" when the procedure concludes with the closure of the planes and does not result in the creation of a stoma. Traqueostomas can be qualified with adjectives indicating permanence (temporary/permanent), size (large/small), shape (round/elliptical), or depth, without being linked to any specific disease or surgical indication. Not all permanent traqueostomas are the result of total laryngectomies, and they do not necessarily have an irreversible character systematically.
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Affiliation(s)
- Serafín Sánchez-Gómez
- Servicio de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - Elena Molina-Fernández
- Servicio de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | - Fernando López-Álvarez
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Beatriz Tena-García
- Servicio de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Landry V, Christopoulos A, Guertin L, Bissada E, Tabet P, Berania I, Royal-Lajeunesse É, Olivier MJ, Ayad T. Patterns of alaryngeal voice adoption and predictive factors of vocal rehabilitation failure following total laryngectomy. Head Neck 2023; 45:2657-2669. [PMID: 37646494 DOI: 10.1002/hed.27491] [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: 01/09/2023] [Revised: 07/10/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE We aimed to determine patterns of alaryngeal voice acquisition and predictive factors of vocal rehabilitation (VR) failure following total laryngectomy (TL) at a large Canadian tertiary care center. METHODS All consecutive patients having undergone a TL between January 1st, 2011 and December 31st, 2019, at the Centre Hospitalier de l'Université de Montréal were included. RESULTS One hundred and ninety-seven laryngectomized patients were identified. Successful VR was achieved in 86 (59.0%) patients, while 59 (41.0%) failed to use a method of alaryngeal voice as their principal means of communication at 1 year postoperatively. The use of tracheoesophageal puncture (TEP) was associated with higher VR success rates (70.6%) when compared with the artificial larynx (48.6%), and esophageal voice (18.8%). The only independent predictor of VR failure on multivariate analysis at all time points was a low socioeconomic status. CONCLUSION Failure to adopt an alaryngeal voice following TL is highly prevalent, despite comprehensive and free speech language pathologist services being offered at our center. A low resort to TEP at our institution and a poor acceptability and accessibility of alternative VR methods may contribute to this trend. The challenges of VR may be further exacerbated by the barriers linked to a lower socioeconomic status, which in turn may contribute to reduced candidacy for TEP.
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Affiliation(s)
- Vivianne Landry
- Faculty of Medicine, University of Montreal, Montréal, Québec, Canada
| | - Apostolos Christopoulos
- Division of Otolaryngology - Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
| | - Louis Guertin
- Division of Otolaryngology - Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
| | - Eric Bissada
- Division of Otolaryngology - Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
| | - Paul Tabet
- Division of Otolaryngology - Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
| | - Ilyes Berania
- Division of Otolaryngology - Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
| | - Émilie Royal-Lajeunesse
- Division of Otolaryngology - Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
| | - Marie-Jo Olivier
- Division of Otolaryngology - Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
- Division of Otolaryngology - Head and Neck Surgery, Maisonneuve-Rosemont Hospital, Montréal, Québec, Canada
| | - Tareck Ayad
- Division of Otolaryngology - Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
- Division of Otolaryngology - Head and Neck Surgery, Maisonneuve-Rosemont Hospital, Montréal, Québec, Canada
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4
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Alcalá Rueda I, Sánchez Barrueco Á, Cenjor Español C, Castaño AB, Villacampa Aubá JM. Everything but the squeal: a guide for head and neck surgery training on the live porcine model. Eur Arch Otorhinolaryngol 2023; 280:2927-2936. [PMID: 36826522 PMCID: PMC10175473 DOI: 10.1007/s00405-023-07882-5] [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: 01/19/2023] [Accepted: 02/08/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE The porcine model has been demonstrated to be cost-effective for head and neck surgery training. There is no literature describing the porcine head and neck anatomy. The purpose of this study is to provide a porcine surgical guide for training head and neck residents. METHODS Five head and neck dissections were performed under general anesthesia on the Large White pig model in the animal facilities of the University Hospital Fundación Jiménez. Sessions were photographed, and reference anatomical measurements were taken. RESULTS The sternum-chin distance (x = 15.80 cm, σ = 0.44), chin-chin distance (x = 11.10 cm, σ = 2.30), prelaryngeal musculature length (x = 10.30 cm, σ = 1.92) and supraomohyoid triangle area (x = 7.07 cm2, σ = 3.91) were among the measurements obtained. The porcine head and neck anatomy was detailed. CONCLUSIONS Head and neck porcine anatomy was thoroughly described, with emphasis on the similarities with human anatomy. The porcine model is capable of simulating human anatomy for surgery training.
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Affiliation(s)
- Ignacio Alcalá Rueda
- Alfonso X El Sabio University (UAX), Madrid, Spain.,Otolaryngology Department, University Hospital General de Villalba, Madrid, Spain
| | - Álvaro Sánchez Barrueco
- Alfonso X El Sabio University (UAX), Madrid, Spain. .,Otolaryngology Department, University Hospital General de Villalba, Madrid, Spain. .,Otolaryngology Department, University Hospital Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain.
| | - Carlos Cenjor Español
- Otolaryngology Department, University Hospital Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
| | - Abel Bogoya Castaño
- Otolaryngology Department, University Hospital Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
| | - José Miguel Villacampa Aubá
- Alfonso X El Sabio University (UAX), Madrid, Spain.,Otolaryngology Department, University Hospital General de Villalba, Madrid, Spain.,Otolaryngology Department, University Hospital Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
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5
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Decreased Complications After Total Laryngectomy Using a Clinical Care Pathway. Ochsner J 2021; 21:272-280. [PMID: 34566509 PMCID: PMC8442219 DOI: 10.31486/toj.20.0070] [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] [Indexed: 11/23/2022] Open
Abstract
Background: Complications following total laryngectomy can lead to increased hospital length of stay (LOS) and increased health care costs. Our objective was to determine the efficacy of a clinical care pathway for improving outcomes for patients following total laryngectomy. Methods: This quality improvement study included all adult patients undergoing total laryngectomy—either primary or salvage—at a tertiary referral center between January 2013 and December 2018. The primary outcome was hospital LOS measured in postoperative days. The total and specific postoperative complication frequencies were evaluated, as well as 30-day readmission rates and intensive care unit (ICU) LOS. Results: Sixty-three patients were included in the study: 29 (46.0%) patients before the pathway implementation and 34 (54.0%) patients after pathway implementation. Demographic characteristics between the groups were similar. The prepathway cohort had a higher rate of total complications compared to the postpathway group (relative risk=0.5; 95% CI 0.3-1.0), although the differences in individual complications were similar. The median LOS of 10 days was the same for the 2 cohorts. The median ICU LOS was 1 day greater in the postpathway cohort, but no difference was seen in rates of ICU readmission in the 2 groups. The 30-day readmission rate also was not significant between the 2 groups. Conclusion: Implementation of a postoperative order set pathway for patients undergoing laryngectomy is associated with decreased overall complication rates. Use of a clinical care pathway may improve outcomes in patients undergoing total laryngectomy.
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6
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Santos FHT, da Silva AR, Tourinho AMC, Erath B. Influence of position and angulation of a voice prosthesis on the aerodynamics of the pseudo-glottis. J Biomech 2021; 125:110594. [PMID: 34237659 DOI: 10.1016/j.jbiomech.2021.110594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/01/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
The use of a tracheoesophageal valve, also known as voice prosthesis, is currently the most appealing solution for recovering the ability to speak in subjects who have undergone a total laryngectomy. The prosthesis allows the passage of air from the trachea to the esophagus, thereby promoting the flow-induced vibration of the subject's pharyngoesophageal segment. In turn, the pharyngoesophageal segment modulates the air flow from the lungs into the subject's vocal tract, acting as an alternative source of acoustic energy to generate voice. The vibration of the pharyngoesophageal segment will likely depend on the aerodynamic forces acting on its wall, which will be defined by the flow characteristics downstream from the valve's outlet. Previous works have investigated the pressure drop across different prosthesis designs with both in-vitro and in-vivo experiments. Nevertheless, the aerodynamic aspects of the flow in the tracheoesophageal region have only been investigated experimentally in an idealized geometry. This work investigates the influence of the prosthesis position on the aerodynamic behavior of the pharyngoesophageal segment in terms of wall pressure distribution and characteristics of the velocity field. The investigations were carried out with a static model of the tracheoesophageal region based on the finite volume method and a Reynolds-averaged Navier-Stokes solver. The geometry of the system was based on computed tomography images obtained from laryngectomized subjects during phonation at different voice registers and included the geometry of a commercially available voice prosthesis. The results suggest that the position and angulation of the voice prosthesis have a minor influence on the pressure loss along the tracheoesophageal segment and on the pressure distribution on the pharyngoesophageal segment's wall.
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Affiliation(s)
- Fernando H T Santos
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Andrey R da Silva
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
| | - André M C Tourinho
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Byron Erath
- Department of Mechanical and Aeronautical Engineering, Clarkson University, Potsdam, NY, USA
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7
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Cox SR, McNicholl K, Shadle CH, Chen WR. Variability of Electrolaryngeal Speech Intelligibility in Multitalker Babble. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:2012-2022. [PMID: 32870708 PMCID: PMC8740568 DOI: 10.1044/2020_ajslp-20-00092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/08/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
Purpose The purpose of this study was to report the variability of electrolarynx (EL) users' speech intelligibility in quiet and in multitalker babble. Method Ten EL users (five Servox® Digital, five TruTone™) who were at least 2 years postlaryngectomy provided recordings of five sentences from the 1965 Revised List of Phonetically Balanced Sentences. Recordings were judged by two groups of naïve listeners in quiet and in the presence of multitalker babble. Fifteen listeners orthographically transcribed a total of 750 sentences containing 3,750 key words in quiet, and another 15 listeners orthographically transcribed the same sentences mixed with multitalker babble. Results Significant differences in speech intelligibility were observed between listening conditions; 17.9% more key words were correctly identified in quiet compared to multitalker babble. Significant differences in fundamental frequency (F0) standard deviation and range but not speech intelligibility were observed between EL device types. A positive correlation of moderate significance was observed between F0 standard deviation and intelligibility for TruTone users in multitalker babble. Conclusions Findings suggest that listeners are able to identify a significantly higher percentage of EL users' speech in quiet compared to multitalker babble, but a large variability in EL users' speech intelligibility exists. Continued investigation involving a larger number of EL users is necessary to confirm this study's findings. Future research should explore the relationships among F0 measures, speaker characteristics (e.g., rate of speech, articulatory precision), and speech intelligibility, in addition to improving alaryngeal rehabilitation training protocols for EL users.
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Affiliation(s)
- Steven R. Cox
- Department of Communication Sciences and Disorders, Adelphi University, Garden City, NY
| | - Kimberly McNicholl
- Department of Communication Sciences and Disorders, Adelphi University, Garden City, NY
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8
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Rameau A. Pilot study for a novel and personalized voice restoration device for patients with laryngectomy. Head Neck 2019; 42:839-845. [PMID: 31876090 DOI: 10.1002/hed.26057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/06/2019] [Accepted: 12/10/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The main modalities for voice restoration after laryngectomy are the electrolarynx, and the tracheoesophageal puncture [Correction added on 30 January 2020 after first online publication: The preceding sentence has been revised. It originally read "The main modalities for voice restoration after laryngectomy are the electrolarynx and the tracheoesophageal puncture."]. All have limitations and new technologies may offer innovative alternatives via silent speech. OBJECTIVE To describe a novel and personalized method of voice restoration using machine learning applied to electromyographic signal from articulatory muscles for the recognition of silent speech in a patient with total laryngectomy. METHODS Surface electromyographic (sEMG) signals of articulatory muscles were recorded from the face and neck of a patient with total laryngectomy who was articulating words silently. These sEMG signals were then used for automatic speech recognition via machine learning. Sensor placement was tailored to the patient's unique anatomy, following radiation and surgery. A personalized wearable mask covering the sensors was designed using 3D scanning and 3D printing. RESULTS Using seven sEMG sensors on the patient's face and neck and two grounding electrodes, we recorded EMG data while he was mouthing "Tedd" and "Ed." With data from 75 utterances for each of these words, we discriminated the sEMG signal with 86.4% accuracy using an XGBoost machine-learning model. CONCLUSIONS This pilot study demonstrates the feasibility of sEMG-based alaryngeal speech recognition, using tailored sensor placement and a personalized wearable device. Further refinement of this approach could allow translation of silently articulated speech into a synthesized voiced speech via portable devices.
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Affiliation(s)
- Anaïs Rameau
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, Sean Parker Institute for the Voice, New York, New York
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9
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Gourin CG, Stewart CM, Frick KD, Fakhry C, Pitman KT, Eisele DW, Austin JM. Association of Hospital Volume With Laryngectomy Outcomes in Patients With Larynx Cancer. JAMA Otolaryngol Head Neck Surg 2019; 145:62-70. [PMID: 30476965 DOI: 10.1001/jamaoto.2018.2986] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance A volume-outcome association exists for larynx cancer surgery, but to date it has not been investigated for specific surgical procedures. Objectives To characterize the volume-outcome association specifically for laryngectomy surgery and to identify a minimum hospital volume threshold associated with improved outcomes. Design, Setting, and Participants In this cross-sectional study, the Nationwide Inpatient Sample was used to identify 45 156 patients who underwent laryngectomy procedures for a malignant laryngeal or hypopharyngeal neoplasm between January 2001 and December 2011. The analysis was performed in 2018. Hospital laryngectomy volume was modeled as a categorical variable. Main Outcomes and Measures Associations between hospital volume and in-hospital mortality, complications, length of hospitalization, and costs were examined using multivariate logistic regression analysis. Results Among 45 156 patients (mean age, 62.6 years; age range, 20-96 years; 80.2% male) at 5516 hospitals, higher-volume hospitals were more likely to be teaching hospitals in urban locations; were more likely to treat patients who had hypopharyngeal cancer, were of white race/ethnicity, were admitted electively, had no comorbidity, and had private insurance; and were more likely to perform flap reconstruction or concurrent neck dissection. After controlling for all other variables, hospitals treating more than 6 cases per year were associated with lower odds of surgical and medical complications, with a greater reduction in the odds of complications with increasing hospital volume. High-volume hospitals in the top-volume quintile (>28 cases per year) were associated with decreased odds of in-hospital mortality (odds ratio, 0.45; 95% CI, 0.23-0.88), postoperative surgical complications (odds ratio, 0.63; 95% CI, 0.50-0.79), and acute medical complications (odds ratio, 0.63; 95% CI, 0.48-0.81). A statistically meaningful negative association was observed between very high-volume hospital care and the mean incremental length of hospitalization (-3.7 days; 95% CI, -4.9 to -2.4 days) and hospital-related costs (-$4777; 95% CI, -$9463 to -$900). Conclusions and Relevance Laryngectomy outcomes appear to be associated with hospital volume, with reduced morbidity associated with a minimum hospital volume threshold and with reduced mortality, morbidity, length of hospitalization, and costs associated with higher hospital volume. These data support the concept of centralization of complex care at centers able to meet minimum volume thresholds to improve patient outcomes.
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Affiliation(s)
- Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - C Matthew Stewart
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Kevin D Frick
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins Carey Business School, Baltimore, Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Karen T Pitman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - J Matthew Austin
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
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10
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Carroll-Alfano MA. Education, counseling, support groups, and provider knowledge of total laryngectomy: The patient's perspective. JOURNAL OF COMMUNICATION DISORDERS 2019; 82:105938. [PMID: 31557689 DOI: 10.1016/j.jcomdis.2019.105938] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 06/19/2019] [Accepted: 09/06/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE Studies over a 40 year period have reported inadequate education and counseling for persons with laryngectomy; however, several long-term trends, including centralization of laryngectomy surgeries in major teaching hospitals, the rise of the internet, and the increased use of the tracheoesophageal prosthesis (TEP) for voice all have the potential to improve this situation. This study investigated if persons with total laryngectomy reported receiving adequate education and counseling before and after their laryngectomy, and how this varied by gender, geographic setting, communication method, and time. It also examined who participated in in-person and online support groups, and what health care providers and settings are perceived as most knowledgeable about laryngectomy. METHODS This research was a cross-sectional study, with 200 participants meeting the inclusion criteria. Results were analyzed via descriptive statistics, Pearson chi-square test, McNemar's test, Fisher's exact test, and one-way ANOVA with post-hoc analysis. RESULTS About half of persons with total laryngectomy reported receiving adequate education and counseling pre- and post-surgery, with men being more likely to report adequate education than women, and persons using a TEP for voice more likely to report adequate education than persons using alternate communication methods. Most participants (71%) participated in support groups, with women more likely to participate than men. Participants in rural areas were less likely to participate in in-person support groups than those from suburban or urban areas. Participants using a TEP as a communication method were more likely to participate in in-person support groups than those using other communication methods. Doctors, speech-language pathologists (SLPs), the internet, and support groups were highly rated sources of information. Among health-care providers, ENTs and SLPs were rated as the most knowledgeable, and primary-care physicians, dentists, and emergency medical technicians the least. CONCLUSIONS There continues to be a need for adequate education and counseling both before and after surgery. This education and counseling may need to continue for months or years post-surgery, due to the traumatic nature of the laryngectomy procedure. Doctors and SLPs can play a leading part in providing education and counseling, and with other health professions and in-person and online support groups also having a role to play. Frontline health care providers are perceived as having low knowledge of laryngectomy.
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Affiliation(s)
- Miriam A Carroll-Alfano
- Department of Communication Science and Disorders, Saint Xavier University, 3700 W 103rd St., Chicago, IL 60655, United States(1).
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11
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Nakayama M, Orosco RK, Holsinger FC, Spriano G, Succo G, De Virgilio A, Oridate N. Endoscopic Transoral Hybrid Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy. Ann Otol Rhinol Laryngol 2019; 129:273-279. [DOI: 10.1177/0003489419885139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The hybrid supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP, that is, open partial horizontal laryngectomies OPHL Type IIa) has been described using a flexible next generation robotic surgical platform for manipulation. We sought to evaluate the feasibility of performing this procedure using endoscopic transoral (EndoT) surgical techniques without robotics. Methods: Preclinical cadaveric study using two human cadavers. Hybrid SCPL-CHEP was performed with a flexible endoscope for visualization and hand-held instruments for manipulation (SILS Hook monopolar and Dissect, HAVAS LaryngoFIT malleable straight jaw instruments, and Stratafix 4-0 spiral knotless barbed suture). Results: EndoT hybrid SCPL-CHEP was successfully performed. The hand-manipulated rigid instruments allowed for transoral incisions and mucosal suturing. We provide the procedural steps of EndoT hybrid techniques. Conclusions: EndoT hybrid SCPL-CHEP was technically feasible in the preclinical cadaveric laboratory setting and appeared comparable to the hybrid SCPL-CHEP via transoral robotic surgery (TORS). Selected handheld instruments and flexible endoscopy appear to facilitate minimally invasive surgery of the larynx. This novel procedure and technique warrant further clinical study for consideration of feasibility, applicability, and patient benefit.
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Affiliation(s)
- Meijin Nakayama
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Ryan K. Orosco
- Division of Head and Neck Surgery, University of California San Diego, La Jolla, CA, USA
| | - F. Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, USA
| | - Giuseppe Spriano
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Rozzano and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Giovanni Succo
- Oncology Department, University of Turin and Head and Neck Oncology Unit, Candiolo Cancer Institute, Candiolo, Turin, Italy
| | - Armando De Virgilio
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Rozzano and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Nobuhiko Oridate
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
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YouTube™ as a source of information for patients undergoing laryngectomy: a thematic analysis. Eur Arch Otorhinolaryngol 2019; 276:3213-3219. [PMID: 31388759 DOI: 10.1007/s00405-019-05590-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Total laryngectomy and end tracheal stoma formation are often required to treat advanced laryngeal cancer. Resources on the internet are commonly accessed by patients as a source of healthcare information. YouTube™, the most popular video-hosting website, is one such resource. The aims of this study were to assess the thematic content of the most viewed YouTube™ videos concerning laryngectomy for laryngeal cancer and to evaluate user response to these videos. METHOD A search of YouTube™ was performed and data were extracted from videos with > 100 views. Upload source, number of views, likes, dislikes and comments were collected and the content of comments was analysed. User response was compared between upload sources using Kruskal-Wallis testing. Inductive thematic analysis of video content was performed to identify overarching themes and subthemes. RESULTS A total of 96 videos were identified, 16 uploaded by patients, 24 by individual healthcare professionals and 56 by professional healthcare institutions. There were 1214,503 views and no significant differences in the number of views, likes or dislikes between upload sources. Three overarching themes and 17 subthemes were identified. Comments were most frequently characterised as offering praise. CONCLUSION YouTube™ has been shown to be a popular platform for sharing information about laryngectomy for laryngeal cancer. There is a lack of data concerning the quality of this information, however, and future work should focus on assessing this. Trusted institutions could make use of this medium to disseminate high-quality information to their patients, and to the wider public.
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Morse E, Judson B, Husain Z, Burtness B, Yarbrough W, Sasaki C, Cheraghlou S, Mehra S. National treatment times in oropharyngeal cancer treated with primary radiation or chemoradiation. Oral Oncol 2018; 82:122-130. [DOI: 10.1016/j.oraloncology.2018.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/24/2018] [Accepted: 02/11/2018] [Indexed: 10/16/2022]
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Sethi RKV, Deschler DG. National trends in primary tracheoesophageal puncture after total laryngectomy. Laryngoscope 2017; 128:2320-2325. [DOI: 10.1002/lary.27066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/02/2017] [Accepted: 11/22/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Rosh K. V. Sethi
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston Massachusetts U.S.A
| | - Daniel G. Deschler
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston Massachusetts U.S.A
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15
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Hone RWA, Rahman E, Wong G, Annan Y, Alexander V, Al-Lami A, Varadharajan K, Parker M, Simo R, Pitkin L, Mace A, Ofo E, Balfour A, Nixon IJ. Do salivary bypass tubes lower the incidence of pharyngocutaneous fistula following total laryngectomy? A retrospective analysis of predictive factors using multivariate analysis. Eur Arch Otorhinolaryngol 2016; 274:1983-1991. [PMID: 28011997 PMCID: PMC5340845 DOI: 10.1007/s00405-016-4391-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/11/2016] [Indexed: 01/12/2023]
Abstract
Salivary bypass tubes (SBT) are increasingly used to prevent pharyngocutaneous fistula (PCF) following laryngectomy and pharyngolaryngectomy. There is minimal evidence as to their efficacy and literature is limited. The aim of the study was to determine if SBT prevent PCF. The study was a multicentre retrospective case control series (level of evidence 3b). Patients who underwent laryngectomy or pharyngolaryngectomy for cancer or following cancer treatment between 2011 and 2014 were included in the study. The primary outcome was development of a PCF. Other variables recorded were age, sex, prior radiotherapy or chemoradiotherapy, prior tracheostomy, type of procedure, concurrent neck dissection, use of flap reconstruction, use of prophylactic antibiotics, the suture material used for the anastomosis, tumour T stage, histological margins, day one post-operative haemoglobin and whether a salivary bypass tube was used. Univariate and multivariate analysis were performed. A total of 199 patients were included and 24 received salivary bypass tubes. Fistula rates were 8.3% in the SBT group (2/24) and 24.6% in the control group (43/175). This was not statistically significant on univariate (p value 0.115) or multivariate analysis (p value 0.076). In addition, no other co-variables were found to be significant. No group has proven a benefit of salivary bypass tubes on multivariate analysis. The study was limited by a small case group, variations in tube duration and subjects given a tube may have been identified as high risk of fistula. Further prospective studies are warranted prior to recommendation of salivary bypass tubes following laryngectomy.
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Affiliation(s)
- Robert W A Hone
- Faculty of Medical Science, Post Graduate Medical Institute, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex, UK.
- Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK.
| | - Eqramur Rahman
- Faculty of Medical Science, Post Graduate Medical Institute, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex, UK
| | - Gentle Wong
- Ear, Nose and Throat Department, Brighton and Sussex University Hospital, 177 Preston Rd, Brighton, UK
| | - Yvette Annan
- Ear, Nose and Throat Department, Charing Cross Hospital, Fulham Palace Rd, London, UK
| | - Victoria Alexander
- Ear, Nose and Throat Department, Guy's Hospital, Great Maze Pond, London, UK
| | - Ali Al-Lami
- Ear, Nose and Throat Department, St Georges Hospital, Blackshaw Rd, London, UK
| | - Kiran Varadharajan
- Ear, Nose and Throat Department, William Harvey Hospital, Kennington Road, Willesborough, Ashford, Kent, UK
| | - Michael Parker
- Faculty of Medical Science, Post Graduate Medical Institute, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex, UK
| | - Ricard Simo
- Ear, Nose and Throat Department, Guy's Hospital, Great Maze Pond, London, UK
| | - Lisa Pitkin
- Ear, Nose and Throat Department, Royal Surrey County Hospital, Egerton Rd, Guildford, Surrey, UK
| | - Alasdair Mace
- Ear, Nose and Throat Department, Charing Cross Hospital, Fulham Palace Rd, London, UK
| | - Enyinnaya Ofo
- Ear, Nose and Throat Department, William Harvey Hospital, Kennington Road, Willesborough, Ashford, Kent, UK
| | - Alistair Balfour
- Ear, Nose and Throat Department, St Georges Hospital, Blackshaw Rd, London, UK
| | - Iain J Nixon
- Ear, Nose and Throat Department, St Georges Hospital, Blackshaw Rd, London, UK
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16
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Gitomer SA, Hutcheson KA, Christianson BL, Samuelson MB, Barringer DA, Roberts DB, Hessel AC, Weber RS, Lewin JS, Zafereo ME. Influence of timing, radiation, and reconstruction on complications and speech outcomes with tracheoesophageal puncture. Head Neck 2016; 38:1765-1771. [PMID: 27394060 PMCID: PMC5118069 DOI: 10.1002/hed.24529] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/04/2016] [Accepted: 05/06/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We evaluated the impact of radiation, reconstruction, and timing of tracheoesophageal puncture (TEP) on complications and speech outcomes. METHODS Retrospective review identified 145 patients who underwent TEP between 2003 and 2007. RESULTS Ninety-nine patients (68%) had primary and 46 (32%) had secondary TEP, with complications occurring in 65% and 61%, respectively (p = .96). Twenty-nine patients (20%) had major complications (18 primary and 11 secondary; p = .42). Ninety-four patients (65%) had pre-TEP radiation, 39 (27%) post-TEP radiation, and 12 (8%) no radiation. With patients grouped by TEP timing and radiation history, there was no difference in complications, fluency, or TEP use. With mean 4.7-year follow-up, 82% primary and 85% secondary used TEP for primary communication (p = .66). Free-flap patients used TEP more commonly for primary communication after secondary versus primary TEP (90% vs 50%; p = .02). CONCLUSION Primary and secondary tracheoesophageal speakers experience similar high rates of complications. Extent of pharyngeal reconstruction, rather than radiation, may be more important in selection of TEP timing. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1765-1771, 2016.
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Affiliation(s)
- Sarah A. Gitomer
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
- Bobby R. Alford Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Kate A. Hutcheson
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Brandon L. Christianson
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Madeleine B. Samuelson
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Denise A. Barringer
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Dianna B. Roberts
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Amy C. Hessel
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Randal S. Weber
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Jan S. Lewin
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Mark E. Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
- Bobby R. Alford Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
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Nouraei S, Mace A, Middleton S, Hudovsky A, Vaz F, Moss C, Ghufoor K, Mendes R, O'Flynn P, Jallali N, Clarke P, Darzi A, Aylin P. A stratified analysis of the perioperative outcome of 17623 patients undergoing major head and neck cancer surgery in England over 10 years: Towards an Informatics-based Outcomes Surveillance Framework. Clin Otolaryngol 2016; 42:11-28. [DOI: 10.1111/coa.12649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- S.A.R. Nouraei
- Department of Otolaryngology - Head & Neck Surgery Surgery; University College Hospital NHS Foundation Trust; London UK
- National Institute of Health and Care Excellence (NICE) 2013 Scholar; London UK
- The Ear Institute; University College London; London UK
| | - A.D. Mace
- Department of Otolaryngology - Head & Neck Surgery; Imperial College Healthcare NHS Trust; London UK
| | | | - A. Hudovsky
- Department of Clinical Coding; Imperial College Healthcare NHS Trust; London UK
| | - F. Vaz
- Department of Otolaryngology - Head & Neck Surgery Surgery; University College Hospital NHS Foundation Trust; London UK
| | - C. Moss
- Department of Oral & Maxillofacial Surgery; University College Hospital NHS Foundation Trust; London UK
| | - K. Ghufoor
- Department of Otolaryngology - Head & Neck Surgery; Barts Health, Royal London Hospital; London UK
| | - R. Mendes
- Department of Clinical Oncology; University College Hospital NHS Foundation Trust; London UK
| | - P. O'Flynn
- Department of Otolaryngology - Head & Neck Surgery Surgery; University College Hospital NHS Foundation Trust; London UK
| | - N. Jallali
- Department of Plastic & Reconstructive Surgery; Imperial College Healthcare NHS Trust; London UK
| | - P.M. Clarke
- Department of Otolaryngology - Head & Neck Surgery; Imperial College Healthcare NHS Trust; London UK
| | - A. Darzi
- Academic Surgical Unit; Department of Surgery & Cancer; St Mary's Hospital; London UK
| | - P. Aylin
- Dr Foster Unit at Imperial College; Department of Primary Care and Public Health; Imperial College London; London UK
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18
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O'Shea MP, Teeling M, Bennett K. Regional variation in medication-taking behaviour of new users of oral anti-hyperglycaemic therapy in Ireland. Ir J Med Sci 2014; 184:403-10. [PMID: 24859371 DOI: 10.1007/s11845-014-1132-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/28/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few studies have investigated regional variation in medication-taking behaviour. The purpose of this study was to investigate whether there are regional differences in non-persistence and non-adherence to oral anti-hyperglycaemic agents in patients initiating therapy and examine if any association exists between different types of comorbidity in terms of medication-taking behaviour. METHODS The Irish Health Services Executive (HSE) pharmacy claims database was used to identify new users of metformin or sulphonylureas, aged ≥25 years, initiating therapy between June 2009 and December 2010. Non-persistence and non-adherence were examined up to 12 months post-initiation. Comorbidity was assessed using modified RxRisk and RxRisk-V indices, and classified as either concordant and/or discordant with diabetes. Adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for non-persistence were determined in relation to both HSE region and comorbidity type using Cox proportional hazards model, adjusting for age, sex and initial OAH prescribed. Logistic regression analysis, adjusting for these covariates, was used to determine the adjusted odds ratios (ORs) and 95% CIs for non-adherence for both HSE region and comorbidity type. RESULTS Results showed little overall difference between regions. The largest reduction for both non-persistence (HR 0.86, 95% CI 0.80, 0.94) and non-adherence (OR 0.83, 95% CI 0.74, 0.93) was observed in the south. Any comorbidity was associated with a reduced risk of non-persistence and non-adherence. CONCLUSIONS Interventions to optimise medication-taking in patients with T2DM should be implemented nationally to improve the overall level of adherence and persistence, especially in patients with no comorbidity.
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Affiliation(s)
- M P O'Shea
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Science, St James's Hospital, Dublin 8, Ireland,
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Abstract
OBJECTIVE To determine if the number of total laryngectomies (TL) performed in California has changed over a 15-year period from 1996 to 2010. We also sought to investigate if the location of surgery, length of stay, use of rotational/free flaps, cost, and complications changed over this period. STUDY DESIGN Cross-sectional. SETTING California Hospital Inpatient Discharge Data sets. SUBJECTS AND METHODS All patient records enlisting International Classification of Diseases, Ninth Revision, Clinical Modification procedural codes for total/radical laryngectomy were extracted from 1996 to 2010 data sets. Patients' demographics were evaluated. Hospitals were coded as university medical centers (UMCs) vs others. Population-adjusted surgery rates, percentage of surgeries with rotational/free flap and/or percutaneous endoscopic gastrostomy (PEG), length of stay, total charges, and disposition status were then analyzed and compared between UMCs and non-UMCs. RESULTS A total of 4145 TLs were performed in California during 1996 to 2010. The overall number of surgeries declined from 1.3 to 0.6 per 100,000 California residents (P < .001). The number of surgeries performed in non-UMCs dropped by 70% during this period (P < .001). The median length of stay increased from 10 to 12 days, and the median total charges increased from $45,000 to $192,000 over the 15-year period. The use of rotational/free flaps more than doubled, and the use of PEG tubes increased 7-fold. CONCLUSION The total number of TLs in California has declined and surgeries are currently being performed equally at UMCs and non-UMCs. The use of rotational/free flaps, costs, hospital stay length, and complications have increased over the past 15 years.
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Affiliation(s)
- Sunil P Verma
- University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California Irvine School of Medicine, Irvine, California, USA
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