Cricopharyngeal Myotomy in National Surgical Quality Improvement Program (NSQIP): Complications for Otolaryngologists Versus Non-otolaryngologists

Abstract

Objective: Comparing outcomes after cricopharyngeal myotomy (CM) performed by otolaryngologists (OTO) and non-otolaryngologists (NO).Methods: A retrospective analysis of the 2014-19 ACS-NSQIP database (American College of Surgeons National Surgical Quality Improvement Program) of patients who underwent open CM (CPT code 43030) as their primary procedure. Analyzed variables include medical comorbidities, operative time, the total length of stay, readmission, reoperation, concurrent procedures, postoperative complications, and postoperative diagnoses. 183 patients were included, 97 (53%) females and 86 (47%) males. 120 had surgery by OTO and 63 by NO.Results: There were no differences in preoperative morbidity. OTO had more outpatient surgeries compared to NO (p<.001). OTO had a longer mean operating time (p=.008). OTO had a higher proportion of concurrent laryngeal procedures and other unspecified procedures compared to NO, while NO had a higher proportion of concurrent esophageal procedures (p=.028). The total length of stay was not significantly different between the two groups. 5.8% OTO and 7.9% NO patients were readmitted for a related reason (p=.586). Complications were similar between the two groups (p>.05). NO had more postop diagnoses of acquired diverticula and achalasia of the stomach cardia, while OTO had more diagnoses of dysphagia and muscular dystrophy (p<.001).Conclusion: There were differences in the surgical setting, length of procedure, concurrent procedures, and postop diagnoses between NO and OTO surgeons but similar complication rates.

Managing Complications Following Endoscopic Myotomy as a Treatment for Upper Esophageal Sphincter (UES) Achalasia: A Case Report

“…This rare case of idiopathic cricopharyngeal achalasia represents an uncommon cause of severe dysphagia in an otherwise healthy adult without a history of stroke, radiation therapy, or a congenital predisposition for pharyngoesophageal dysfunction. While endoscopic esophageal myotomy is a recommended definitive treatment for this condition, the possibility of procedure-induced complications exists and must not be overlooked [ 1 - 2 ]. Managing postoperative esophageal stenosis will likely be the responsibility of the gastroenterology care team.…”

Therapie der Sialorrhoe mit Botulinumtoxin – ein Update

“…In Fällen von Öffnungsstörungen des oberen Ösophagussphinkters bzw. bei rekurrenten Beschwerden nach Botulinumtoxininjektion kann eine cricopharyngeale Myotomie in Erwägung gezogen werden [61,62,111,112].…”