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: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: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.
