Objective To examine factors associated with hospital safety net burden and its impact on survival for patients with sinonasal squamous cell carcinoma (SNSCC). Study Design Retrospective database study. Setting National Cancer Database from 2004 to 2016. Methods SNSCC cases were identified in the National Cancer Database. Hospital safety net burden was defined by percentage of uninsured/Medicaid patients treated, namely ≤25% for low-burden hospitals, 26% to 75% for medium-burden hospitals, and >75% for high-burden hospitals (HBHs). Univariate and multivariate analyses were used to investigate patient demographics, clinical characteristics, and overall survival. Results An overall 6556 SNSCC cases were identified, with 1807 (27.6%) patients treated at low-burden hospitals, 3314 (50.5%) at medium-burden hospitals, and 1435 (21.9%) at HBHs. On multivariate analysis, Black race (odds ratio [OR], 1.39; 95% CI, 1.028-1.868), maxillary sinus primary site (OR, 1.31; 95% CI, 1.036-1.643), treatment at an academic/research program (OR, 20.63; 95% CI, 8.868-47.980), and treatment at a higher-volume facility ( P < .001) resulted in increased odds of being treated at HBHs. Patients with grade III/IV tumor (OR, 0.70; 95% CI, 0.513-0.949), higher income ( P < .05), or treatment modalities other than surgery alone ( P < .05) had lower odds. Survival analysis showed that hospital safety net burden status was not significantly associated with overall survival (log-rank P = .727). Conclusion In patients with SNSCC, certain clinicopathologic factors, including Black race, lower income, treatment at an academic/research program, and treatment at facilities in the West region, were associated with treatment at HBHs. Hospital safety net burden status was not associated with differences in overall survival. Level of evidence 4.
Objectives To investigate the impact of facility volume on Patient Safety Indicator (PSI) events following transsphenoidal pituitary surgery (TSPS). Study Design Retrospective database review. Setting National Inpatient Sample database (2003-2011). Methods The National Inpatient Sample was queried for TSPS cases from 2003 to 2011. Facility volume was defined by tertile of average annual number of TSPS procedures performed. PSIs, based on in-hospital complications identified by the Agency of Healthcare Research and Quality, and poor outcomes, such as mortality and tracheostomy, were analyzed. Results An overall 16,039 cases were included: 804 had ≥1 PSI and 15,235 had none. A greater proportion of male to female (5.8% vs 4.3%) and Black to White (7.0% vs 4.5%) patients experienced PSIs. There was an increased likelihood of poor outcome (odds ratio [OR], 3.1 [95% CI, 2.5-3.7]; P < .001) and mortality (OR, 30.1 [95% CI, 18.5-48.8]; P < .001) with a PSI. The incidence rates of PSIs at low-, intermediate-, and high-volume facilities were 5.7%, 5.1%, and 4.2%, respectively. Odds of poor outcome with PSIs were greater at low-volume facilities (OR, 3.3 [95% CI, 2.4-4.4]; P < .001) vs intermediate (OR, 3.1 [95% CI, 2.1-4.2]; P < .001) and high (OR, 2.5 [95% CI, 1.7-3.8]; P < .001). Odds of mortality with PSIs were greater at high-volume facilities (OR, 43.0 [95% CI, 14.3-129.4]; P < .001) vs intermediate (OR, 40.0 [95% CI, 18.5-86.4]; P < .001) and low (OR, 17.3 [95% CI, 8.0-37.7]; P < .001). Conclusion PSIs were associated with a higher likelihood of poor outcome and mortality following TSPS. Patients who experienced PSIs had a lower risk of poor outcome but increased mortality at higher-volume facilities.
Background While extramedullary plasmacytomas are infrequently encountered plasma cell malignancies, most cases occur in the head and neck, with a predilection for the sinonasal cavity. Due to the rarity of this disease, the majority of studies on sinonasal extramedullary plasmacytoma (SN-EMP) are case reports or small retrospective case series. Objective To investigate the impact of patient, disease, and treatment factors on the survival of patients with SN-EMP. Methods The National Cancer Database was queried for all patients with SN-EMP between 2004–2016 (N = 381 cases). Univariate and multivariate analyses were used to examine patient demographics, tumor characteristics, and survival. Results The majority of SN-EMP patients were over 60 years old (57.0%), male (69.8%), and white (86.2%). The most common treatment modality was radiotherapy alone (38.6%), followed by surgery plus radiotherapy (37.8%). Five-year overall survival was 74.0% and median survival was 9.1 years. Accounting for patient demographics and tumor characteristics in a multivariate model, the following groups had worse prognosis: 60 and older (HR 1.99, p = 0.031) and frontal sinus primary site (HR 11.56, p = 0.001). Patients who received no treatment (HR 3.89, p = 0.013), chemotherapy alone (HR 5.57, p = 0.008) or radiotherapy plus chemotherapy (HR 2.82, p = 0.005) had significantly lower survival than patients who received radiotherapy alone. Patients who received surgery with radiotherapy (HR 0.57, p = 0.039) had significantly higher survival than patients who received radiotherapy alone. Conclusion In patients with SN-EMP five-year overall survival was found to be 74.0% with decreased survival associated with a frontal sinus primary site and being aged 60 or older. Patients receiving no treatment, chemotherapy alone, or radiotherapy with chemotherapy was associated with lower survival. Receiving surgery plus radiotherapy was associated with the highest five-year overall survival.
ObjectiveTo investigate the survival benefit of elective neck dissection (END) over neck observation in cT1‐4 N0M0 head and neck verrucous carcinoma (HNVC).Study DesignRetrospective cohort study.SettingThe 2006 to 2017 National Cancer Database.MethodsPatients with surgically resected cT1‐4 N0M0 HNVC were selected. Linear, binary logistic, Kaplan‐Meier, and Cox proportional hazards regression models were utilized.ResultsOf 1015 patients satisfying inclusion criteria, 223 (22.0%) underwent END. The majority of patients were male (55.4%) and white (91.0%) with disease of the oral cavity (67.6%) classified as low grade (90.0%) and cT1‐2 (81.8%). The minority of ENDs (4.0%) detected occult nodal metastases. The rate of END increased from 2006 to 2017 for both cT1‐2 (16.3% vs 22.0%, p = .126, R2 = 0.405) and cT3‐4 (41.7% vs 70.0%, p = .424, R2 = 0.232) disease but these trends were not statistically significant. Independent predictors of undergoing END included treatment at an academic facility (adjusted odds ratio [aOR]: 1.75, 95% confidence interval [CI]: 1.19‐2.55), cT3‐4 disease (aOR: 3.31, 95% CI: 2.16‐5.07), and tumor diameter (aOR: 1.09, 95% CI: 1.01‐1.19) (p < 0.05). The 5‐year overall survival (OS) of patients treated with and without END was 71.3% and 70.6%, respectively (p = .661). END did not significantly reduce the 5‐year hazard of death (adjusted hazard ratio: 1.25, 95% CI: 0.91‐1.71, p = .172). END did not significantly improve 5‐year OS in univariate and multivariate analyses stratified by several patient, facility, tumor, and treatment characteristics.ConclusionEND does not confer an appreciable survival benefit in HNVC, even after stratifying univariate and multivariate analyses by several patient, facility, tumor, and treatment characteristics.Level of EvidenceLevel 4.
Background Although recent studies have identified an association between race and adverse outcomes in head and neck surgeries, there are limited data examining the impact of racial disparities on adult inpatient outcomes following epistaxis management procedures. Objective To analyze the association between race and adverse outcomes in hospitalized patients undergoing epistaxis treatment. Methods This retrospective cohort analysis utilized the 2003 to 2014 National Inpatient Sample. International Classification of Diseases, Ninth Revision codes were used to identify cases with a primary diagnosis of epistaxis that underwent a procedure for epistaxis control. Cases with missing data were excluded. Higher total charges and prolonged length of stay (LOS) were indicated by values greater than the 75th percentile. Demographics, hospital characteristics, Elixhauser comorbidity score, and complications were compared among race cohorts using univariate chi-square analysis and one-way analysis of variance (ANOVA). The independent effect of race on adverse outcomes was analyzed using multivariate binary logistic regression while adjusting for the aforementioned variables. Results Of the 83 356 cases of epistaxis included, 80.3% were White, 12.5% Black, and 7.2% Hispanic. Black patients had increased odds of urinary/renal complications (odds ratio [OR] 2.148, 95% confidence interval [CI] 1.797-2.569, P < .001) compared to White patients. Additionally, Black patients experienced higher odds of prolonged LOS (OR 1.227, 95% CI 1.101-1.367, P < .001) and higher total charges (OR 1.257, 95% CI 1.109-1.426, P < .001) compared to White patients. Similarly, Hispanic patients were more likely to experience urinary/renal complications (OR 1.605, 95% CI 1.244-2.071, P < .001), higher total charges (OR 1.519, 95% CI 1.302-1.772, P < .001), and prolonged LOS (OR 1.157, 95% CI 1.007-1.331, P = .040) compared to White patients. Conclusion Race is an important factor associated with an increased incidence of complications in hospitalized patients treated for epistaxis.
Introduction: Blepharoplasty is a commonly performed cosmetic procedure which can help reduce age-related changes around the eyes. Like other surgical procedures, patient satisfaction is highly correlated with physician responsiveness to questions. As social media becomes more popular, patients are increasingly turning to online sources of information such as Realself.com , a website where patients can ask questions to verified physicians. We extracted and analyzed blepharoplasty-related questions on Realself to gain greater understanding of commonly asked pre- and postoperative questions. Materials and Methods: A Web crawler was used to gather the text for each question under the search term “eyelid surgery.” Questions were individually assigned by the authors to respective pre- or postoperative categories. Preoperative categories included eligibility for surgery, nonsurgical options, potential adverse effects, surgeon recommendations, surgical techniques and logistics, ability to pursue other surgeries following blepharoplasty, cost, and miscellaneous. Postoperative question categories included symptoms after surgery, appearance, behavior allowed/disallowed, options to revise surgery, and miscellaneous. Machine learning was then utilized to establish the most common pre- and postoperative questions. Results: 2009 blepharoplasty questions were extracted in total. A total of 60.93% of questions were preoperative related and 39.07% of questions were postoperative related. Preoperative questions were predominantly about eligibility for surgery (43.85%), while the majority of postoperative question were related to symptoms after surgery (17.42%) and appearance (10.80%). Machine learning analysis showed that most preoperative questions inquired about the possibility of correcting specific features, whereas most postoperative questions focused on resolving complications following surgery. Conclusion: As health information becomes more prevalent online, our results underscore the need for greater awareness about frequently asked questions to help surgeons preemptively address patient concerns about blepharoplasty. Our 10 most common questions can be used in the clinical setting as a patient educational handout to augment the preoperative experience.
Objectives To study differences in care of patients admitted for epistaxis during the weekend compared to the weekday. Study Design Retrospective database review. Setting 2003 to 2014 National Inpatient Sample. Methods Patients admitted for a primary diagnosis of epistaxis were extracted from the National Inpatient Sample from 2003 to 2014. Univariate and multivariate analyses were applied to assess differences in patient demographics, clinical characteristics, treatment, and outcomes between weekend and weekday admissions. Results A total of 39,329 cases were included in our study cohort, with 28,458 weekday admissions and 10,892 weekend admissions. There was no significant difference in patient race, gender, insurance status, hospital ownership status, or location between weekend and weekday admissions (p > .05). Most weekend admissions were emergent (82.2%) and were treated with packing (51.8%). Upon performing logistic regression, the likelihood of emergent admission (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.32‐1.51, p < .001) and prolonged length of stay (OR 1.11, 95% CI 1.05‐1.17, p < .001) was higher for weekend admissions versus weekday admissions. Moreover, odds of packing for epistaxis were significantly higher (OR 1.14, 95% CI 1.09‐1.19, p < .001) on the weekend, while odds of ligation (OR 0.88, 95% CI 0.80‐0.97, p = .013) and endovascular arterial embolization (OR 0.74, 95% CI 0.65‐0.84, p < .001) were lower. There were no significant differences in in‐hospital mortality, patient discharge disposition, and total hospital charges (p > .05). Conclusion Patients primarily admitted for epistaxis over the weekend were more likely to be emergent, experienced prolonged length of stay, and be treated nonoperatively with packing, than weekday admissions. No significant differences in patient insurance or hospital ownership were identified. Level of Evidence: 4.
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