Objectives: To determine the representation of women in leadership positions within otolaryngology societies and to compare their academic rank and research productivity to men. Methods: The leadership positions of all U.S. otolaryngology societies were compiled. The Medicare Physician Compare database was used to obtain gender and medical school graduation year for all otolaryngologists. An online search was used to determine board member's academic faculty rank. The Scopus database was used to determine an individual's number of publications, citations, and h-index. All websites were accessed from July 2019 to October 2019. Results: Of the 200 leadership positions, there were 160 unique individuals available for analysis. Of those, 23% were female. In comparison, 18% of all otolaryngologists in the United States are female. The average medical school graduation year was significantly more recent for female leaders (1997 vs. 1990, P < .001) than males, which is similar to all otolaryngologists (2001 vs. 1993, P < .001). Stratifying by gender alone, women averaged significantly fewer publications, citations, and h-indices compared to men (P < .05), and were also less likely to be professors (P < .01). When considering both gender and graduation year, significant differences among academic productivity were only noted for those graduating between 1990 to 1999. Among all board members who graduated after 2000, women comprised a majority of those in leadership positions (52%). Conclusion: Leadership positions in otolaryngology societies reflect the changing demographic of otolaryngologists in the United States. There is proportionate representation, and the more recently graduated female physicians show the same research productivity as their male counterparts.
Objectives: Review the incidence and factors associated with respiratory compromise requiring intensive care unit level interventions in children with planned admission to the pediatric intensive care unit (PICU) following tonsillectomy or adenotonsillectomy (T/AT). Study design: Retrospective cohort study. Methods: Review of all patients with PICU admissions following T/AT from 2015 to 2020 at a tertiary care pediatric hospital. Patient demographics, underlying comorbidities, operative data, and respiratory complications during PICU admission were extracted. Results: Seven hundred and seventy-two patients were admitted to the PICU following T/AT, age 6.1 ± 4.6 years. All children were diagnosed with obstructive sleep apnea or sleep-disordered breathing (mean pre-operative apnea-hypopnea index 29 ± 26.5 and O2 nadir 77.1% ± 11.1). Neuromuscular disease, enteral feed dependence, and obesity were common findings (N = 240 (31%), N = 106 (14%), and N = 209 (27%) respectively). Overall, 29 patients (3.7%) developed respiratory compromise requiring PICU-level support, defined as new-onset continuous or bilevel positive airway pressure support (n = 25) or reintubation (n = 9). Three patients were diagnosed with pulmonary edema. Multivariable regression analysis demonstrated pre-operative oxygen nadir and enteral feed dependence were associated with respiratory compromise (OR = 0.97, 95% CI 0.94-0.99, P = .04; OR = 6.3, 95% CI 2.36-52.6, P = .001 respectively). Conclusions: Our study found respiratory compromise in 3.7% of patients with planned PICU admissions following T/AT. Oxygen nadir and enteral feeds were associated with higher respiratory compromise rates. Attention should be given to these factors in planning for post-operative disposition.
Background: Feeding difficulty is a known complication of congenital heart surgery. Despite this, there is a relative sparsity in the available data regarding risk factors, incidence, associated symptoms, and outcomes. Methods: In this retrospective chart review, patients aged 0–18 years who underwent congenital heart surgery at a single institution between January and December, 2017 were reviewed. Patients with feeding difficulties before surgery, multiple surgeries, and potentially abnormal recurrent laryngeal nerve anatomy were excluded. Data collected included patient demographics, feeding outcomes, post-operative symptoms, flexible nasolaryngoscopy findings, and rates of readmission within a 1-year follow-up period. Multivariable regression analyses were performed to evaluate the risk of an alternative feeding plan at discharge and length of stay. Results: Three-hundred and twenty-six patients met the inclusion criteria for this study. Seventy-two (22.09%) were discharged with a feeding tube and 70 (97.22%) of this subgroup were younger than 12 months at the time of surgery. Variables that increased the risk of being discharged with a feeding tube included patient age, The Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery score, procedure group, aspiration, and reflux. Speech-language pathology was the most frequently utilised consulting service for patients discharged with feeding tubes (90.28%) while other services were not frequently consulted. The median length of stay was increased from 4 to 10 days for patients who required an enteral feeding tube at discharge. Discussion: Multidisciplinary management protocol and interventions should be developed and standardised to improve feeding outcomes following congenital heart surgery.
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