Safety of Outpatient Type 1 Thyroplasty

Patel, Jena; Boon, Maurits; Spiegel, Joseph R.; Huntley, Colin

doi:10.1177/0145561319894414

Cited by 10 publications

(37 citation statements)

References 27 publications

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“…The average age of our group was 60 years old, similar to previous studies, 13,14,17 showing that primarily older adults undergo LFS. While concerns exist regarding increased complications with elderly patients, we did not observe an association between complication and age.…”

Section: Discussionsupporting

confidence: 90%

“…One of the main reasons for overnight observation is the concern for airway complications, which may result in catastrophic outcomes that require tracheostomy or intubation. We observed a low rate of airway intervention (0.7%) similar to multiple prior studies, 7,13,14,23,24 demonstrating that these procedures, though involving manipulation of the airway, rarely necessitate airway intervention such as reintubation. However, tracheostomy rate could not be specifically evaluated in this study.…”

Section: Discussionsupporting

confidence: 85%

“…[7][8][9]11,23,25 There is the concern that airway compromise requiring intervention was more prevalent in AA, 9,11 however, in our cohort, the presence of AA was not associated with unplanned reintubation. Multiple retrospective studies [12][13][14]18,19,26 demonstrate that patients presenting with respiratory distress and laryngeal edema following LFS are frequently treated with steroids and observation, and do not require surgical treatment. The ability of patients to obtain timely, nonsurgical treatment for potential airway concerns favors the safety of performing these surgeries as an outpatient.…”

Section: Discussionmentioning

confidence: 99%

“…7,9,10 The more serious complications are thought to be seen more frequently in AA. 7,11 While recent studies have demonstrated that LFS is safe to be performed as an outpatient procedure due to a low percentage of patients with immediate complications, [12][13][14] risk factors leading to admission or increased complication rates remain undetermined. Identification of these risk factors for complications may help better target postoperative observation to select patients undergoing LFS.…”

Section: Introductionmentioning

confidence: 99%

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Safety and Predictors of 30‐Day Adverse Events of Laryngeal Framework Surgery: An Analysis of ACS‐NSQIP data

et al. 2021

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Objectives/Hypothesis: To characterize and identify predictors of 30-day adverse events in patients undergoing laryngeal framework surgery (LFS).Study Design: This study is a retrospective analysis of the National Surgical Quality Improvement dataset. Methods: LFS cases were identified from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database from 2008 to 2018. Demographic variables, patient comorbidities, and perioperative outcomes (any adverse event, 30-day readmission, 30-day reoperation, and unplanned intubation) were extracted. Patient-specific and surgery-specific factors associated with perioperative adverse events were examined using descriptive statistics and univariate logistic regression (LR).Results: Of 283 patients who underwent LFS, 225 underwent laryngoplasty medialization, 56 underwent laryngoplasty medialization with arytenoidectomy or arytenoidopexy via an external approach, and 2 underwent local myocutaneous or fasciocutaneous advancement flap along with laryngoplasty. Medical comorbidities were present in 33.6% of patients and 57.9% were American Society of Anesthesiologists (ASA) Class III/IV (57.9%). LFS was performed as same-day surgery in 30.7% of cases. Fourteen patients (4.9%) suffered an adverse condition within 30 days following surgery. In univariate LR, ASA Class III or IV (odds ratio [OR] 4.6, 95% confidence interval [CI] 1.2-30.1) was the only predictor associated with any adverse event. Arytenoid adduction (AA) was associated with increased risk of reoperation within 30 days of the initial surgery (OR 6.4, 95% CI 1.0-49).Conclusions: LFS is a generally safe procedure with infrequent perioperative adverse events. In the ACS-NSQIP database, ASA classification of III or IV was associated with a higher risk for any 30-day adverse event and AA was associated with a higher risk for 30-day reoperation.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Safety and Predictors of 30‐Day Adverse Events of Laryngeal Framework Surgery: An Analysis of ACS‐NSQIP data

et al. 2021

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“…Indeed, laryngeal immobilities can be managed in ambulatory by laryngoplasty, laryngeal reinnervation or thyroplasty. 25 Complications of a medialization thyroplasty are usually transient dysphonia and hematoma that do not occur in the immediate postoperative period, but rather after a few days. Therefore, it is possible to let the patient go home on the same day and to follow up with outpatient consultations.…”

Section: Surgical Expertisementioning

confidence: 99%

Ambulatory ENT Surgery: Eight Years of Experience in A Tropical Environment

Zounon

Vodouhe

Oke

et al. 2022

BJOHNS

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Introduction Ambulatory surgery allows minimizing the time spent in the hospital, which could reduce the transmission of nosocomial pathologies and the occupation of hospital resources and infrastructures. The objective of the study was to assess the ambulatory activity of the ENT department of Military Teaching Hospital of Cotonou since its creation. Materials and methods The study was monocentric retrospective covering an eight-year period from January 1, 2013, to January 1, 2021. It concerned all ENT surgeries where the patient was discharged on the same day, regardless of the type of anaesthesia used. A pre-established survey form was used to collect data from the medical records. The variables studied were socio-demographic factors, eligibility criteria, indications and conversion to inpatient mode. Results Over the study period half of the procedures performed (334 patients) corresponded to indications for outpatient surgery and then were included. Of these, 130 patients (38.9%) were rejected for various contraindications like geographical and financial accessibility and communication difficulties. A total of 204 patients (61.1%) underwent ENT ambulatory surgery. The sex ratio was 3 males to 5 females (0.6). Children under 15 years of age accounted for 43.7% (n=146). Tonsillectomy with or without adenoidectomy was the most frequent surgery accounting for half of the outpatient surgery cases. Pharyngeal surgery was the most performed: (126 patients) followed by cervico-facial surgery (44 patients). Reconversion to inpatient mode occurred in 39 patients (19.12%). No respiratory complications were noted. No deaths were recorded. Conclusions Ambulatory care is a mode of management mainly used for pharyngeal surgery, in particular tonsillectomy and adenoidectomy in children. The main contraindications to patient eligibility were geographical and financial accessibility and communication difficulties. This activity would benefit from being better structured with specific staff and premises.

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Preliminary Experience with 3‐Dimensional Exoscope‐Assisted Laryngoplasty

Sanuki,

Takemoto,

Sumiya

et al. 2023

The Laryngoscope

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ObjectiveLaryngoplasty requires the manipulation of the vocal folds, which are not visible during the operation. The widespread use of this technique is limited by the need for adequate knowledge of anatomy, the small surgical field, and the high level of skill required for the procedure. An exoscope has been developed to provide a stereoscopic view similar to that of a microscope while using the same compact endoscopic tool. This study aimed to determine whether the three‐dimensional (3D) exoscopic surgical technique could be applied to laryngoplasty and explore its possibility to ultimately replace the current approach.MethodsThis was a retrospective case series analysis, which included 28 patients with hoarseness who underwent surgery with (Exoscope; n = 12) or without (Macrosurgery; n = 16) a 3D exoscope between July 2018 and February 2021. The feasibility of performing all surgical steps with the 3D exoscope was evaluated. The Exoscope and Macrosurgery groups were compared for surgical time, vocal function outcomes, and complications. Questionnaires were completed by medical staff regarding the usefulness of medical education.ResultsNo intraoperative or postoperative complications occurred in either procedure. The operative time was similar in both groups. The vocal function outcomes were also comparable between the groups. Questionnaires revealed that the exoscope was useful in terms of sharing information on surgical procedures and anatomy, as well as functioning as an educational tool.ConclusionWhile this was a preliminary study, our results indicated that the exclusive use of the 3D exoscope was feasible for open approaches.Level of EvidenceLevel IV Laryngoscope, 2023

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Safety of Outpatient Type 1 Thyroplasty

Cited by 10 publications

References 27 publications

Safety and Predictors of 30‐Day Adverse Events of Laryngeal Framework Surgery: An Analysis of ACS‐NSQIP data

Safety and Predictors of 30‐Day Adverse Events of Laryngeal Framework Surgery: An Analysis of ACS‐NSQIP data

Ambulatory ENT Surgery: Eight Years of Experience in A Tropical Environment

Preliminary Experience with 3‐Dimensional Exoscope‐Assisted Laryngoplasty

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