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:This study evaluates the influence of facility volume and type on the treatment and outcomes of pituitary adenoma(PA).Methods:The 2004-2016 National Cancer Database was queried for patients with PA receivin...Objectives:This study evaluates the influence of facility volume and type on the treatment and outcomes of pituitary adenoma(PA).Methods:The 2004-2016 National Cancer Database was queried for patients with PA receiving definitive treatment.Tumor size represented the largest diameter of the primary tumor.Results:A total of 89,863 patients(53.8%female)with a mean age and tumor size of(51.0±18.0)years(Mean±SD,later the same)and(19.5±13.2)mm,respectively,were included.Patients were managed at 1,241 unique facilities,categorized into 1057 low-volume(treating approximately<10 patients annually),142 intermediate-volume(treating approximately 10-30 patients annually),and 42 high-volume facilities(treating approximately 31-105 patients annually).Increasing facility volume and academic centers were both associated with higher rates of surgical treatment as well as lower rates of radiotherapy and shorter postoperative length of hospitalization(allp<0.001).Kaplan-Meier log-rank analysis showed that increasing facility volume and academic centers were both significantly associated with improved overall survival(p<0.001).On multivariate Cox-regression analysis after adjusting for age,gender,Charlson-Deyo comorbidity index,tumor size,treatment type,and facility type,treatment at intermediate-volume(HR 1.238,95%CI 1.155-1.329,p<0.001)and low-volume facilities(HR=1.413,95%CI 1.306-1.528,p<0.001)were independent risk factors of all-cause mortality,while facility type was not independently associated with overall survival.Conclusion:Management and outcomes of PA appear to be dependent on the treatment facility volume,with high-volume facilities,but not necessarily facility type,being associated with improved outcomes overall.展开更多
The current literature lacks strong guidelines regarding surgical management of patients with aspirin-exacerbated respiratory disease(AERD),who present with the clinical triad of chronic rhinosinusitis with nasal poly...The current literature lacks strong guidelines regarding surgical management of patients with aspirin-exacerbated respiratory disease(AERD),who present with the clinical triad of chronic rhinosinusitis with nasal polyposis(CRSwNP),bronchial asthma,and aspirin/nonsteroidal anti-inflammatory drug intolerance.To further define the effectiveness of sinus surgery in treating AERD patients,this review article discusses current evidence regarding outcomes associated with more extensive surgery,the benefits of frontal sinus surgery on polyposis,and the role of Draf III intervention.Numerous studies suggest that Draf III frontal sinusotomy may be an efficacious early intervention due to increased neo-ostial patency and subsequent distribution of topical therapies.Future studies that further investigate the efficacy and safety of extensive surgery in AERD patients are warranted.展开更多
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.
基金National Institute of General Medical Sciences of the National Institutes of Health(Grant/Award Number:T32GM008620(AA))。
文摘Objectives:This study evaluates the influence of facility volume and type on the treatment and outcomes of pituitary adenoma(PA).Methods:The 2004-2016 National Cancer Database was queried for patients with PA receiving definitive treatment.Tumor size represented the largest diameter of the primary tumor.Results:A total of 89,863 patients(53.8%female)with a mean age and tumor size of(51.0±18.0)years(Mean±SD,later the same)and(19.5±13.2)mm,respectively,were included.Patients were managed at 1,241 unique facilities,categorized into 1057 low-volume(treating approximately<10 patients annually),142 intermediate-volume(treating approximately 10-30 patients annually),and 42 high-volume facilities(treating approximately 31-105 patients annually).Increasing facility volume and academic centers were both associated with higher rates of surgical treatment as well as lower rates of radiotherapy and shorter postoperative length of hospitalization(allp<0.001).Kaplan-Meier log-rank analysis showed that increasing facility volume and academic centers were both significantly associated with improved overall survival(p<0.001).On multivariate Cox-regression analysis after adjusting for age,gender,Charlson-Deyo comorbidity index,tumor size,treatment type,and facility type,treatment at intermediate-volume(HR 1.238,95%CI 1.155-1.329,p<0.001)and low-volume facilities(HR=1.413,95%CI 1.306-1.528,p<0.001)were independent risk factors of all-cause mortality,while facility type was not independently associated with overall survival.Conclusion:Management and outcomes of PA appear to be dependent on the treatment facility volume,with high-volume facilities,but not necessarily facility type,being associated with improved outcomes overall.
文摘The current literature lacks strong guidelines regarding surgical management of patients with aspirin-exacerbated respiratory disease(AERD),who present with the clinical triad of chronic rhinosinusitis with nasal polyposis(CRSwNP),bronchial asthma,and aspirin/nonsteroidal anti-inflammatory drug intolerance.To further define the effectiveness of sinus surgery in treating AERD patients,this review article discusses current evidence regarding outcomes associated with more extensive surgery,the benefits of frontal sinus surgery on polyposis,and the role of Draf III intervention.Numerous studies suggest that Draf III frontal sinusotomy may be an efficacious early intervention due to increased neo-ostial patency and subsequent distribution of topical therapies.Future studies that further investigate the efficacy and safety of extensive surgery in AERD patients are warranted.
