Use of continuous positive airway pressure after rhinoplasty, septoplasty, and sinus surgery: A survey of current practice patterns

Cohen, Eli; Larrabee, Yuna C.; Weinstein, Andrew L.; Stewart, Michael G.

doi:10.1002/lary.25336

Cited by 17 publications

(24 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a recent survey, 407 rhinoplasty surgeons reported that many of them temporarily suspend CPAP after nasal surgery, typically for a period of 1 to 2 weeks. 33 In the same study, many surgeons reported suspending CPAP postoperatively with minimal complications. The lack of uniformity on OSA screening preoperatively and reintroduction of postoperative CPAP poses a potential health burden on the patient.…”

Section: Osa and Rhinoplastymentioning

confidence: 95%

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Ishii

Tollefson

Basura

et al. 2017

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

Objective. Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work.The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre-and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri-and postoperative strategies to maximize patient safety and to optimize surgical results for patients.Purpose. The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are also intended to include the caregiver if the patient is <18 years of age.Action Statements. The Guideline Development Group made the following recommendations: (1) Clinicians should ask all patients seeking rhinoplasty about their motivations for surgery and their expectations for outcomes, should provide feedback on whether those expectations are a realistic goal of surgery, and should document this discussion in the medical record. (2) Clinicians should assess rhinoplasty candidates for comorbid conditions that could modify or contraindicate surgery, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs. (3) The surgeon, or the surgeon's designee, should evaluate the rhinoplasty candidate for...

show abstract

Section: Osa and Rhinoplastymentioning

confidence: 95%

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Ishii

Tollefson

Basura

et al. 2017

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

show abstract

“…2-9 Otolaryngologists frequently encounter scenarios where PAP therapy is purposely withheld postoperatively, such as endoscopic sinus surgery, where there is currently no consensus on the use of postoperative PAP. 10…”

mentioning

confidence: 99%

Risk of Postoperative Complications in Patients with Obstructive Sleep Apnea following Skull Base Surgery

Huyett¹,

Soose²,

Schell³

et al. 2018

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

Objectives Obstructive sleep apnea (OSA) presents several challenges in skull base surgery, including increased intracranial pressure, worsened OSA with nasal packing, and avoidance of positive airway pressure (PAP) therapy postoperatively. The objective of this study was to examine the risk of postoperative complications in a skull base population with OSA in which PAP therapy is withheld. Study Design Retrospective cohort study. Setting Tertiary care hospital. Subjects and Methods Medical records of 414 adult patients undergoing anterior skull base procedures between January 1, 2014, and January 7, 2017, were retrospectively reviewed. Revision surgeries, skull base infections, sinus surgery, and orbital cases were excluded. Results Fifty-four (13.0%) patients with a diagnosis of OSA were identified. While the known patients with OSA were more likely to require postoperative supplemental oxygen (odds ratio [OR], 4.29; 95% confidence interval [CI], 2.38-7.75; P < .001), there was no increased risk of serious respiratory events or cerebrospinal fluid leak (CSF). To address the likely underdiagnosis of OSA in this cohort, subgroup analyses were performed of patients at high risk for OSA (body mass index >30 kg/m and hypertension) and demonstrated an increased risk of serious respiratory events (OR, 4.41; 95% CI, 1.24-15.7; P = .034) and CSF leak (13.6% vs 4.7%; P = .018). Conclusions Skull base patients with known OSA can be successfully managed with diligent care in the perioperative period when PAP therapy is withheld. However, OSA is likely underdiagnosed in the skull base population, and patients at high risk for undiagnosed OSA may be at the greatest risk for respiratory complications and CSF leak. Increased presurgical awareness and implementation of a perioperative management algorithm is needed.

show abstract

“…Length of activity and CPAP restrictions must balance possible economic and physiologic consequences to patients with the potential for increased risk of postoperative CSF leak. To date, there are no studies assessing effects of postoperative restrictions on CSF leak rates, and only 1 study exploring practice patterns in the use of CPAP after nasal surgery that did not assess CSF leak rates . Thus, postoperative restrictions are an important area of potential future study.…”

Section: Discussionmentioning

confidence: 99%

Perioperative management in endoscopic endonasal skull‐base surgery: a survey of the North American Skull Base Society

Roxbury

Lobo

Kshettry

et al. 2017

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

Background:The objective of this work was to be er understand variations in perioperative management in endoscopic endonasal skull-base surgery (EESBS) and to identify trends in management based upon the practice pa erns of North American Skull Base Society (NASBS) members. Methods:A 29-question survey evaluating perioperative EESBS management was sent to all NASBS members. Responses were analyzed with descriptive statistics. Subgroup analysis was performed based on participant demographics. A Bonferroni correction was performed and a p value <0.01 was considered statistically significant for subgroup analysis.Results: Of 651 invitees, 116 responded (17.8%). Participants were primarily from the United States (81.0%), and practiced in academic centers (83.6%). The majority were neurosurgeons (55.2%) or rhinologists (27.6%). Most surgeons (83.6%) advocated use of preoperative intravenous antibiotics (96.6%) and image guidance in all cases (83.6%). Lumbar drains were not recommended for cases in which an intraoperative cerebrospinal fluid (CSF) leak was not anticipated (94.8%). Nasoseptal flaps (NSFs) were not recommended in cases without intraoperative CSF leak (84.5%), but were recommended in cases of high-flow intraoperative CSF leak (97.4%). While postoperative restrictions were highly variable, most providers recommended CSF leak precautions (89.7%), flying restrictions (94.0%), and driving restrictions (95.6%) regardless of intraoperative CSF leak status. Most experts also recommended that continuous positive airway pressure (CPAP) be avoided for at least 2 weeks when an intraoperative CSF leak is encountered (81.9%). Conclusion:Despite variation in perioperative management of EESBS patients, important trends were identified by this study. Further investigation is needed to standardize perioperative practice pa erns in EESBS. C 2017 ARS-AAOA, LLC.

show abstract

Use of continuous positive airway pressure after rhinoplasty, septoplasty, and sinus surgery: A survey of current practice patterns

Abstract: N/A.

Cited by 17 publications

References 21 publications

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Risk of Postoperative Complications in Patients with Obstructive Sleep Apnea following Skull Base Surgery

Perioperative management in endoscopic endonasal skull‐base surgery: a survey of the North American Skull Base Society

Contact Info

Product

Resources

About