Outcomes and Complications of Balloon and Conventional Functional Endoscopic Sinus Surgery

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Background Studies have not yet examined the trends and risk factors of biphasic and recurrent anaphylaxis in the United States using International Classification of Diseases, tenth revision (ICD‐10) CM codes. The goal of this study is to examine the trends of biphasic and recurrent anaphylaxis in all patient care settings (inpatient, outpatient, emergency department, and observation). Methods We used the Clinformatics database from 2015 to 2017. Our main outcome measure was recurrent anaphylactic events occurring within 1 year after the initial event. We used Cox proportional hazards modeling to assess the factors associated with recurrent anaphylaxis and the Kaplan‐Meier method to estimate time to recurrence. Results There were a total of 19,039 patients with incident anaphylaxis in 2016 and, of these, 2017 had a recurrent anaphylaxis event in the 12‐month period after the index date (10.6%). The most common trigger for recurrent anaphylaxis is venom followed by food allergens. Pediatric patients aged <18 years were more likely to develop recurrent anaphylaxis compared with patients aged 18 to 64 years (hazard ratio [HR], 1.53). Patients with allergic rhinitis and asthma were more likely to develop recurrent anaphylaxis compared to those without these comorbidities (HR, 1.15 and 1.27, respectively). Conclusion This is the first national study using ICD‐10 CM codes looking at rates of biphasic and recurrent anaphylaxis in all patient care settings. Recurrent anaphylaxis is more common in the first 3 days after the initial event, in younger patients (<18 years), and in patients with allergic rhinitis and/or asthma. Physicians need to prescribe epinephrine auto‐injectors and educate their patients about the risk of recurrence.

Section: Discussionsupporting

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Recurrent anaphylaxis in the United States: time of onset and risk factors

Chaaban

Stuart

Watley

et al. 2019

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“…1,2 Of the half million cases of FESS performed annually in the United States, up to 16% of patients require revision surgery. 6,[8][9][10][11][12][13][14][15] Postoperative regimens for irrigations, topical steroids, oral steroids, and antibiotics combined with postoperative endoscopic debridement help contribute to the health of the healing sinus cavities. 19 Scarring of the sinus ostia, adhesion formation, polyposis, and middle turbinate lateralization have all been implicated in surgical failure, necessitating revision surgery or medication delivery to improve healing and reestablish function.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] Approximately 500,000 sinus surgeries are performed annually with 6% to 16% requiring revision surgery because of scarring, adhesion formation, incomplete resection of ethmoid cells, and middle turbinate lateralization with re-obstruction of the drainage pathways. 6,[8][9][10][11][12][13][14][15] One of the most common reasons for revision ESS is middle turbinate lateralization, which causes obstruction in 30% to 78% of revision cases. 10,12,13,15 Endoscopic grading of severity of CRS with the Lund-Kennedy (LK) scoring system, evaluating polyp formation, edema, discharge, scarring, and crusting on a 0 to 2 point scale has been shown to correlate with total SNOT-22 scores.…”

mentioning

confidence: 99%

Comparison of steroid‐releasing stents vs nonabsorbable packing as middle meatal spacers

Rawl

McQuitty

Khan

et al. 2019

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Background A randomized controlled trial was held to compare nonabsorbable packs to steroid‐eluting absorbable stents as middle meatal spacers after endoscopic sinus surgery in patients with chronic rhinosinusitis (CRS). Methods CRS patients were randomly assigned to receive either nonabsorbable Merocel packs wrapped in non‐latex glove material (packing type A) or Propel steroid eluting stents (packing type B). Twenty‐two–item Sino‐Nasal Outcome Test (SNOT‐22) scores were collected preoperatively and postoperatively during the initial 4 debridements up to 3 months. Recording of the nasal endoscopy was also collected during all postoperative visits. In addition, Lund‐Kennedy scores and middle turbinate lateralization scores, using a new visual analogue scale, were compared between the 2 types of packing. Results Forty CRS patients were prospectively enrolled in this institutional review board (IRB)‐approved study. Patients with packing type A had significantly lower middle turbinate lateralization scores at their first (∼10 days) postoperative visit (p = 0.02 and p = 0.04, for left and right sides, respectively). This difference disappeared by later postoperative visits (from 20 days to 3 months). Overall, patients receiving packing type A had significant lower SNOT‐22 scores at 20 days postsurgery (p = 0.05). This difference also disappeared at 1 and 3 months postoperation. There were no statistically significant differences in Lund‐Kennedy scores. Conclusion In this study, nonabsorbable packing materials showed significant superior middle meatal spacing capacities as evidenced by greater middle turbinate medialization capability at the first postoperative visit. Additionally, patients with this type of packing saw improvements in their SNOT‐22 scores at the 20‐day postoperative visit. This study showed that there was no significant improvement in postoperative outcomes with drug‐eluting stents when compared to nonabsorbable packing.

Epidemiology and trends of anaphylaxis in the United States, 2004‐2016

Chaaban

Warren

Baillargeon

et al. 2019

BackgroundNo national study has examined the epidemiology of anaphylaxis after introduction of the codes of the International Statistical Classification of Diseases and Health Related Problems, Tenth Revision, Clinical Modification (ICD‐10 CM). Our objective was to examine the trends in incidence and hospitalization rates in the United States utilizing ICD‐9 and ICD‐10 CM codes.MethodsWe used the Clinformatics database from 2004 to 2016. Our outcome measures included incidence of anaphylaxis and hospitalization trends. Multivariable logistic regression was used to assess the predictors of anaphylaxis and hospitalization.ResultsThere were a total of 462,906 anaphylaxis cases. The incidence increased from 153 in 2004 to 218 in 2016 (per 100,000). Women were 1.19 (95% confidence interval, 1.18‐1.20) times more likely to present with anaphylaxis. Medication‐induced anaphylaxis increased 15‐fold.ConclusionThis is the first population‐based study that included ICD‐10 CM codes to describe the epidemiology of anaphylaxis in the United States. ICD‐10 codes improved the accuracy of medication‐induced anaphylaxis, the most likely etiology to result in hospitalization.