Objectives: Determine if the use of ibuprofen or perioperative ampicillin affect post-tonsillectomy bleeding risk. Investigate other potential risk factors for post-tonsillectomy bleeding. As recommended by the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) tonsillectomy practice guideline, several members of an academic department stopped using perioperative ampicillin and also began using ibuprofen postoperatively. This quality improvement project was designed to determine whether these actions altered bleeding risk. Methods: Case control comparison methodology. A case was defined as any patient who returned to the operating room for cauterization. A control was defined as any patient who did not have known post-operative bleeding. Four randomly selected patients (2 cases and 2 controls) were identified in each month from November 2010 to August 2012 (n = 88). Results: Ibuprofen (odds ratio [OR] = 1.13, P = 0.8), perioperative ampicillin (OR = 0.91, P = 0.9), and postoperative amoxicillin (OR = 1.0, P = 1.0) had no effect on bleeding risk. Several trends were identified: Use of a microdebrider (vs. cautery) was associated with decreased bleeding risk (OR 0.21, P = 0.04). Neurologic/psychosocial comorbidity was associated with increased bleeding risk (OR 2.93, P = 0.06). Positive pre-operative bleeding risk assessment questionnaire was associated with increased bleeding risk (OR 1.76, P = 0.24). Conclusions: The use of ibuprofen and omission of perioperative ampicillin had no effect on the bleeding rate. The role of tonsillectomy technique, neurological/psychosocial comorbidity, and positive bleeding risk questionnaire are being examined prospectively.
further organize them by gender, academic rank, fellowship training status, and institutional location. The Scopus database was used to assess various bibliometrics of these otolaryngologists, including the h-index, number of publications, and publication range (in years).Results: Analysis included 1,127 otolaryngologists, 916 men (81.3%) and 211 women (18.7%). Female faculty comprised 15.4% in the Midwest, 18.8% in the Northeast, 21.3% in the South, and 19.0% in the West (p=0.44). Overall, men obtained significantly higher senior academic ranks (Associate Professor or Professor) compared to women (59.8% vs. 40.2%, p<0.0001). Regional gender differences among senior faculty were found in the South (59.8% men vs. 37.3% women, p=0.0003) and in the Northeast (56.4% men vs. 24.1% women, p<0.0001) with concomitant gender differences in scholarly impact, as measured by the h-index (South, p=0.0003; Northeast, p=0.0001). Among geographic subdivisions, female representation at senior ranks was lowest in the Mid-Atlantic (21.9%), New England (17.1%), and West South Central (33.3%), while highest in the Pacific (60.0%) and Mountain (71.4%) regions. No regional gender differences were found in fellowship training patterns (p-values>0.05).Conclusions: Gender disparities in academic rank and scholarly productivity exist regionally, most notably in the Northeast where women in otolaryngology are most underrepresented relative to men at senior academic ranks and in scholarly productivity.
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