Background:Academic productivity is believed to be correlated with years of experience and departmental rank,yet there is a paucity of granular academic data between rhinology faculty regarding departmental rank and i...Background:Academic productivity is believed to be correlated with years of experience and departmental rank,yet there is a paucity of granular academic data between rhinology faculty regarding departmental rank and industry engagement,and how these relate to experience.Objective:To examine the interrelationships between experience,department rank and reputation,funding,industry engagement,and academic output of rhinology faculty.Methods:Demographics,academic metrics(publications,citations,h-index,National Institutes of Health[NIH]funding),program rankings,and industry compensation for academic U.S.rhinologists through June 2022 were collected and compared between academic rank and years of experience.Results:A cohort of 278 rhinologists were included.Full professors had greater academic metrics(allp<0.001)and industry compensation(allp<0.05)than associate professors,assistant professors,and private practice rhinologists.Full professors were also more likely to receive NIH funding than other groups(p<0.001).Years of experience and industry compensation positively correlated with each other and with academic metrics(allp<0.001)with significant jumps between the 5th-9th and 10th-14th years of practice(p<0.001).However,early career(≤8 years)rhinologists published more articles per year than later career(>8 years)rhinologists(p<0.001).Rhinologists at Doximity top 10 and 25 residency programs by reputation and research output and top 50 U.S.News and World Report departments had significantly greater academic metrics and NIH funding compared to those who were not(p<0.001).Top 10 and 25 reputations was associated with increased industry compensation(p=0.024).Conclusions:Although early career rhinologists published more frequently,ascending professorial rank,years of experience,and affiliation with top-ranked departments were associated with total academic productivity.Industry engagement was linked to reputation and years of experience.展开更多
Objectives:Hospital-acquired catheter-associated urinary tract infections(UTIs)have been regarded as preventable adverse events,yet their risk in endoscopic skull base surgery(ESBS)has not been well described despite ...Objectives:Hospital-acquired catheter-associated urinary tract infections(UTIs)have been regarded as preventable adverse events,yet their risk in endoscopic skull base surgery(ESBS)has not been well described despite common use.We determine the incidence of UTI following ESBS and identify contributing clinical factors.Methods:Retrospective review was conducted for a cohort of 229 consecutive adult patients who underwent endoscopic endonasal surgery for treatment of any skull base pathology between July 2018 and June 2022 at a tertiary academic skull base surgery program.Postoperative UTI comprised the primary outcome.Independent variables included patient demographics,use and length of urinary catheterization,and pre-existing genitourinary conditions.Results:Nosocomial UTIs were identified in 1.3%(3/229)of patients,occurring on postoperative days 2,9,and 14,respectively;all were catheter-associated.Overall,86.0%(197/229)of patients received urinary catheters(mean duration 2.2±1.8 days).Compared to those without,patients with UTI were older(70.0±15.4 vs.52.2±16.8 years,p=0.034),had lengthier stays(94.7±126.8 vs.5.9±8.4 days,p<0.001),and had prolonged catheterizations(9.3±5.5 vs.2.1±1.5 days,p<0.001).Preoperative genitourinary conditions were also associated with UTI development,namely,chronic urinary retention/obstruction(66.7%vs.4.0%,p=0.006),urinary incontinence(66.7%vs.6.2%,p=0.013),prostate disease(100.0%vs.17.8%,p=0.035),and renal dysfunction(100.0%vs.9.7%,p=0.001).Among intraoperative cerebrospinal fluid leak patients,postoperative CSF leak incidence was not associated with catheter use versus nonuse(3.3%vs.12.5%,p=0.276).Conclusion:Although UTIs are uncommon in ESBS patients,advanced age,length of stay,duration of indwelling urinary catheterization,and comorbid genitourinary conditions may elevate risk.展开更多
Objectives:Appropriate scenarios of lumbar drain(LD)use in endonasal skull base surgery is an active area of investigation.However,existing data is limited.The purpose of this study is to evaluate the robustness of th...Objectives:Appropriate scenarios of lumbar drain(LD)use in endonasal skull base surgery is an active area of investigation.However,existing data is limited.The purpose of this study is to evaluate the robustness of the NSQIP database to characterize morbidity and complications associated with LD usage concurrent to minimally invasive resection of pituitary tumors.Methods:A cross-sectional analysis of the American College of Surgeons National Surgical Quality Improvement Program database was used to query patients undergoing transnasal resection of pituitary tumor.Patients were stratified by concurrent perioperative use of LD and outcomes were compared.Results:A total of 1714 patients underwent minimally invasive endonasal(microscopic or endoscopic)pituitary tumor resection,of which LD was concurrently placed in 98(5.7%)cases.Operative time was significantly longer for patients who had LD placed compared to those without(176.5 min(IQR 114.8-229.5)vs.137 min[IQR 100-185]),(p<0.001)with a significantly longer length of stay(5 days[IQR 4-6]vs.3 days[IQR 2-5]),(p<0.001).Multivariate regression demonstrated LD placement was an independent predictor of postoperative medical complication(OR 2.41,95%CI 1.15-5.03,p=0.020)and unplanned readmission(OR 2.06,95%CI 1.02-4.16,p=0.044),but not CSF leak(OR 2.30,95%CI 0.51-10.26;p=0.276).Temporal analysis during the study period demonstrated a decrease in LD use from 8%to 5%(R2=0.60;p=0.025).Conclusions:The NSQIP database provides a large patient population for examining LD use in endoscopic pituitary adenoma resection.LD use for minimally invasive pituitary surgery is associated with postoperative medical complications and unplanned readmissions,with no apparent impact on reconstructive outcomes,and there is overall decreasing usage.Clinical judgment should be exercised in selecting appropriate scenarios for use.展开更多
Objectives:Balloon sinuplasty(BSP)and functional endoscopic sinus surgery(FESS)have undergone changes in utilization over time.This study investigates national trends in BSP and FESS and postoperative outcomes over th...Objectives:Balloon sinuplasty(BSP)and functional endoscopic sinus surgery(FESS)have undergone changes in utilization over time.This study investigates national trends in BSP and FESS and postoperative outcomes over the last decade as well as the impact of Corona Virus Disease 2019(COVID-19)on these trends.Methods:The TriNetX database was queried for patients undergoing either FESS or BSP from 1/1/2011 to 5/4/2024.Data were collected on patient demographics,diagnoses,and postoperative outcomes.Results:A total of 1738 patients underwent BSP and 90,311 underwent FESS.A greater proportion of FESS patients had diabetes(p=0.001),hypertension(p<0.001),and chronic pulmonary disease,p=0.001)compared to BSP whereas a similar proportion of patients for both cohorts had a history of ischemic heart disease(p=0.73).Body mass index was higher for patients undergoing FESS(28.6±6.5)compared to BSP(28.1±6.578;p=0.02).Overall postoperative complications were similar between BSP and FESS(odds ratio[OR]=0.80,95%confidence interval[CI]=0.58-1.09)with similar rates of epistaxis(OR=0.77,95%CI=0.53-1.12)and cerebrospinal fluid(CSF)leak(OR=0.14,95%CI=0.01-2.25).Overall revision rate was higher for FESS(OR=0.34,95%CI=0.21-0.57).Thirty-day readmission(OR=0.44,95%CI=0.29-0.66)and Emergency Department visits(OR=0.51,95%CI=0.28-0.92)were less common in patients who received BSP.Surgical volume consistently increased over time for both cohorts but at a more rapid pace for BSP(425.64%)compared to FESS(274.19%)and a dramatic decrease in volume by 44.85%and 22.28%,respectively,at the onset of COVID-19.Conclusion:Overall,BSP and FESS surgical volume have steadily increased over time with a drastic reduction following the COVID-19 pandemic.BSP and FESS carry different complication profiles emphasizing the importance of patient selection and preoperative counseling.展开更多
文摘Background:Academic productivity is believed to be correlated with years of experience and departmental rank,yet there is a paucity of granular academic data between rhinology faculty regarding departmental rank and industry engagement,and how these relate to experience.Objective:To examine the interrelationships between experience,department rank and reputation,funding,industry engagement,and academic output of rhinology faculty.Methods:Demographics,academic metrics(publications,citations,h-index,National Institutes of Health[NIH]funding),program rankings,and industry compensation for academic U.S.rhinologists through June 2022 were collected and compared between academic rank and years of experience.Results:A cohort of 278 rhinologists were included.Full professors had greater academic metrics(allp<0.001)and industry compensation(allp<0.05)than associate professors,assistant professors,and private practice rhinologists.Full professors were also more likely to receive NIH funding than other groups(p<0.001).Years of experience and industry compensation positively correlated with each other and with academic metrics(allp<0.001)with significant jumps between the 5th-9th and 10th-14th years of practice(p<0.001).However,early career(≤8 years)rhinologists published more articles per year than later career(>8 years)rhinologists(p<0.001).Rhinologists at Doximity top 10 and 25 residency programs by reputation and research output and top 50 U.S.News and World Report departments had significantly greater academic metrics and NIH funding compared to those who were not(p<0.001).Top 10 and 25 reputations was associated with increased industry compensation(p=0.024).Conclusions:Although early career rhinologists published more frequently,ascending professorial rank,years of experience,and affiliation with top-ranked departments were associated with total academic productivity.Industry engagement was linked to reputation and years of experience.
文摘Objectives:Hospital-acquired catheter-associated urinary tract infections(UTIs)have been regarded as preventable adverse events,yet their risk in endoscopic skull base surgery(ESBS)has not been well described despite common use.We determine the incidence of UTI following ESBS and identify contributing clinical factors.Methods:Retrospective review was conducted for a cohort of 229 consecutive adult patients who underwent endoscopic endonasal surgery for treatment of any skull base pathology between July 2018 and June 2022 at a tertiary academic skull base surgery program.Postoperative UTI comprised the primary outcome.Independent variables included patient demographics,use and length of urinary catheterization,and pre-existing genitourinary conditions.Results:Nosocomial UTIs were identified in 1.3%(3/229)of patients,occurring on postoperative days 2,9,and 14,respectively;all were catheter-associated.Overall,86.0%(197/229)of patients received urinary catheters(mean duration 2.2±1.8 days).Compared to those without,patients with UTI were older(70.0±15.4 vs.52.2±16.8 years,p=0.034),had lengthier stays(94.7±126.8 vs.5.9±8.4 days,p<0.001),and had prolonged catheterizations(9.3±5.5 vs.2.1±1.5 days,p<0.001).Preoperative genitourinary conditions were also associated with UTI development,namely,chronic urinary retention/obstruction(66.7%vs.4.0%,p=0.006),urinary incontinence(66.7%vs.6.2%,p=0.013),prostate disease(100.0%vs.17.8%,p=0.035),and renal dysfunction(100.0%vs.9.7%,p=0.001).Among intraoperative cerebrospinal fluid leak patients,postoperative CSF leak incidence was not associated with catheter use versus nonuse(3.3%vs.12.5%,p=0.276).Conclusion:Although UTIs are uncommon in ESBS patients,advanced age,length of stay,duration of indwelling urinary catheterization,and comorbid genitourinary conditions may elevate risk.
文摘Objectives:Appropriate scenarios of lumbar drain(LD)use in endonasal skull base surgery is an active area of investigation.However,existing data is limited.The purpose of this study is to evaluate the robustness of the NSQIP database to characterize morbidity and complications associated with LD usage concurrent to minimally invasive resection of pituitary tumors.Methods:A cross-sectional analysis of the American College of Surgeons National Surgical Quality Improvement Program database was used to query patients undergoing transnasal resection of pituitary tumor.Patients were stratified by concurrent perioperative use of LD and outcomes were compared.Results:A total of 1714 patients underwent minimally invasive endonasal(microscopic or endoscopic)pituitary tumor resection,of which LD was concurrently placed in 98(5.7%)cases.Operative time was significantly longer for patients who had LD placed compared to those without(176.5 min(IQR 114.8-229.5)vs.137 min[IQR 100-185]),(p<0.001)with a significantly longer length of stay(5 days[IQR 4-6]vs.3 days[IQR 2-5]),(p<0.001).Multivariate regression demonstrated LD placement was an independent predictor of postoperative medical complication(OR 2.41,95%CI 1.15-5.03,p=0.020)and unplanned readmission(OR 2.06,95%CI 1.02-4.16,p=0.044),but not CSF leak(OR 2.30,95%CI 0.51-10.26;p=0.276).Temporal analysis during the study period demonstrated a decrease in LD use from 8%to 5%(R2=0.60;p=0.025).Conclusions:The NSQIP database provides a large patient population for examining LD use in endoscopic pituitary adenoma resection.LD use for minimally invasive pituitary surgery is associated with postoperative medical complications and unplanned readmissions,with no apparent impact on reconstructive outcomes,and there is overall decreasing usage.Clinical judgment should be exercised in selecting appropriate scenarios for use.
文摘Objectives:Balloon sinuplasty(BSP)and functional endoscopic sinus surgery(FESS)have undergone changes in utilization over time.This study investigates national trends in BSP and FESS and postoperative outcomes over the last decade as well as the impact of Corona Virus Disease 2019(COVID-19)on these trends.Methods:The TriNetX database was queried for patients undergoing either FESS or BSP from 1/1/2011 to 5/4/2024.Data were collected on patient demographics,diagnoses,and postoperative outcomes.Results:A total of 1738 patients underwent BSP and 90,311 underwent FESS.A greater proportion of FESS patients had diabetes(p=0.001),hypertension(p<0.001),and chronic pulmonary disease,p=0.001)compared to BSP whereas a similar proportion of patients for both cohorts had a history of ischemic heart disease(p=0.73).Body mass index was higher for patients undergoing FESS(28.6±6.5)compared to BSP(28.1±6.578;p=0.02).Overall postoperative complications were similar between BSP and FESS(odds ratio[OR]=0.80,95%confidence interval[CI]=0.58-1.09)with similar rates of epistaxis(OR=0.77,95%CI=0.53-1.12)and cerebrospinal fluid(CSF)leak(OR=0.14,95%CI=0.01-2.25).Overall revision rate was higher for FESS(OR=0.34,95%CI=0.21-0.57).Thirty-day readmission(OR=0.44,95%CI=0.29-0.66)and Emergency Department visits(OR=0.51,95%CI=0.28-0.92)were less common in patients who received BSP.Surgical volume consistently increased over time for both cohorts but at a more rapid pace for BSP(425.64%)compared to FESS(274.19%)and a dramatic decrease in volume by 44.85%and 22.28%,respectively,at the onset of COVID-19.Conclusion:Overall,BSP and FESS surgical volume have steadily increased over time with a drastic reduction following the COVID-19 pandemic.BSP and FESS carry different complication profiles emphasizing the importance of patient selection and preoperative counseling.
