The Laryngoscope
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Public reporting and transparency of patient experience is an emerging national healthcare priority. The objectives of this report are to describe patient satisfaction scores in ambulatory otolaryngology and examine the association of teaching status across multiple service domains. ⋯ Otolaryngology patients evaluated in the teaching setting report lower patient satisfaction overall, primarily related to access to care and visit-specific processes; however, they are more likely to display loyalty and recommend their practice and care provider. The teaching setting does not influence care provider satisfaction scores. Because practice loyalty is most closely correlated to provider-specific behaviors, otolaryngologists may consider enhancement of provider-patient communication to improve patient satisfaction regardless of the practice setting. Academic otolaryngology practices should consider focusing on access systems and process improvement to enhance the overall patient experience.
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Review Meta Analysis
Dexamethasone and postoperative bleeding after tonsillectomy and adenotonsillectomy in children: A meta-analysis of prospective studies.
Tonsillectomy and adenotonsillectomy are common pediatric surgical procedures. Although perioperative administration of dexamethasone is common, recent data indicate a possible association between dexamethasone and increased risk of postoperative hemorrhage. ⋯ There was no overall association between dexamethasone administration and postoperative bleeding in children undergoing tonsillectomy or adenotonsillectomy. However, this study cannot exclude the possibility of an association between specific dexamethasone doses and increased odds of bleeding. The results underscore the need for more dedicated prospective studies of this very common intervention.
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The purpose of this study was to share our clinical experience in the use and accuracy of a newly designed, low-profile titanium mesh (Modus OPS 1.5; Medartis, Basel, Switzerland) for primary internal orbital reconstruction. ⋯ The newly designed, thin titanium mesh is a reliable and safe implant for the repair of orbital defects. Owing to insufficient intraoperative control, two plates showed buckling at the posterior border, which made a repair necessary. Awareness of this problem may avoid such complications in the future. However, it would seem reasonable to improve the stability of the mesh by increasing the profile height, to minimize potential complications.
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Comparative Study
Pulmonary complications after major head and neck surgery: A retrospective cohort study.
Postoperative pulmonary complications (PPCs) following head and neck surgery are common. Patients undergoing tracheostomy, free tissue transfer reconstruction, and postoperative ventilation in an intensive care unit (ICU) have a high incidence of PPCs. We sought to define the incidence of PPCs in this cohort and to determine what factors PPCs correlate with. ⋯ Patients undergoing major head and neck surgery are at high risk of PPCs. Advanced age and hypertension significantly correlated with PPCs. PPCs correlate with prolonged ICU and hospital stays, and increased mortality. Further research is needed to define risk factors, useful investigations, and effective optimization strategies to mitigate PPCs.
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Comparative Study
Predictors of complications of free flap reconstruction in head and neck surgery: Analysis of 304 free flap reconstruction procedures.
The objectives of this study were to classify and analyze perioperative complications following free flap reconstruction in the head and neck and investigate potential predictors of these complications. ⋯ The rate and grade of complications with free flap reconstruction in the head and neck were found to be low. Higher tumor stage and pharyngoesophageal reconstruction were found to be associated with increased complication grades, whereas preoperative radiation alone and chemoradiation were not. Smoking and alcohol use, age, diabetes mellitus, peripheral vascular disease, and preoperative myocardial infarction as well as preoperative cerebrovascular accident were not found to be associated with increased complications. No statistically significant difference in complication grades was found with different flap types or indications for reconstruction.