The primary objective of this pilot study was to define the change in productivity costs followin... more The primary objective of this pilot study was to define the change in productivity costs following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Secondary objectives were to identify CRS-related characteristics that may influence the degree of productivity improvement after ESS. Prospective, multi-institutional, observational cohort study. The human capital approach was used to define productivity costs. Annual absenteeism, presenteeism, and lost leisure time were quantified to define annual lost productive time (LPT). LPT was monetized using the annual daily wage rates obtained from the 2012 US Census and the 2013 US Department of Labor statistics. Twenty-seven patients with refractory CRS who underwent ESS were followed for a mean of 15 months (range, 8-25 months). Following ESS, there were improvements in annual absenteeism (22 days reduced to 3 days), annual presenteeism (41 days reduced to 19 days), and annual household days lost (12 days reduced to 6 days). ...
International forum of allergy & rhinology, Jan 3, 2015
A health utility value represents an individual's preference for living in a specific health ... more A health utility value represents an individual's preference for living in a specific health state and is used in cost-utility analyses. This study investigates the impact of continuing medical therapy on health utility outcomes in patients with chronic rhinosinusitis (CRS). The Medical Outcomes Study Short Form-6D (SF-6D) questionnaire was administered to patients prospectively enrolled in a longitudinal study examining treatment outcomes for CRS. Patients were prescribed robust, initial medical therapy and then elected to continue with medical therapy (n = 40) or undergo endoscopic sinus surgery (ESS), followed by medical therapy (n = 152). Patients observed through treatment crossover to ESS were also evaluated (n = 20). Health utility values (SF-6D) were generated at baseline, 6-months, and 12-months follow-up for both cohorts and evaluated using repeated measures analysis of variance (ANOVA). Treatment crossover patients were found to have a significantly higher prevalence ...
Canadian journal of surgery. Journal canadien de chirurgie
The use of complementary and alternative medicine (CAM) is becoming more common, particularly amo... more The use of complementary and alternative medicine (CAM) is becoming more common, particularly among cancer patients. We sought to define the frequency of CAM use among general surgery, hepatobiliary and surgical oncology patients and to define some of the determinants of CAM use in patients with benign and malignant disease. We asked all patients attending the clinics of 3 hepatobiliary/surgical oncology surgeons from 2002 to 2005 to voluntarily respond on first and subsequent visits to a questionnaire related to the use of CAM. We randomly selected patients for review. We reviewed a total of 490 surveys from 357 patients. Overall CAM use was 27%. There was significantly more CAM use among cancer (34%) versus noncancer patients (21%; p = 0.008), and the use of CAM was more common in patients with unresectable cancer (51%) than resectable cancer (22%; p < 0.001). There was no significant difference in use between men and women. There did not appear to be a change in CAM use with p...
To evaluate the cost-effectiveness of transoral robotic surgery (TORS) compared to intensity-modu... more To evaluate the cost-effectiveness of transoral robotic surgery (TORS) compared to intensity-modulated radiotherapy (IMRT) for early stage (T1-2, N0, M0) oropharyngeal squamous cell carcinoma (OPSCC). A Markov decision tree model with a 5-year time horizon was developed. Comparative groups were: i) TORS with concurrent ipsilateral neck dissection +/- adjunctive IMRT, and ii) primary IMRT. Primary outcome was cost/quality adjusted life year (QALY). Perspective was the United States third party payer. Costs and effects were discounted at a rate of 3.5%. A threshold and probabilistic sensitivity analysis were performed. TORS strategy cost $30,992 and provided 4.81 QALYs/patient. The IMRT strategy cost $26,033 and provided a total of 4.78 QALYs/patient. The incremental cost effectiveness ratio for TORS vs. IMRT in the reference case was $165,300/QALY. The probability that TORS is cost-effective compared to IMRT at a maximum willingness-to-pay threshold of $50,000/QALY is 42%. An IMRT st...
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
Rhinology, which encompasses clinical and surgical treatment of the nasal cavity and paranasal si... more Rhinology, which encompasses clinical and surgical treatment of the nasal cavity and paranasal sinuses, is a growing subspecialty with advances in the surgical, clinical, and research realms. The advancement of this subspecialty and its impact on the practice of otolaryngology, in both academic and nonacademic institutions, is not yet understood. A novel survey created by our research team was mailed out to 150 randomly selected otolaryngology staff and 8 fellowship-trained rhinologists throughout Canada asking questions related to demographics, training, referral patterns, technique, and adequacy of training. One hundred respondents completed the survey, yielding a response rate of 63%. The average age of rhinologists who responded (38 years) was younger than those who were nonrhinologists (50 years). Compared with fellowship-trained rhinologists, nonrhinologists felt less comfortable with cerebrospinal leak repairs, skull base surgery, frontal sinus surgery, paranasal sinus neopla...
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
To understand how newer generation multidetector computed tomographic (NGCT) scanner technology (... more To understand how newer generation multidetector computed tomographic (NGCT) scanner technology (≥ 16 slices) has affected the imaging characteristics of head and neck abscesses. Retrospective chart review.Setting:Tertiary referral centre. Forty-eight patients with a head and neck abscess who underwent a soft tissue neck computed tomographic (CT) scan were identified from September 1, 2001, to December 1, 2008. The degree of rim enhancement, delta (Δ), was graded using mean Hounsfield units (HU) from five peripheral points and five central points from a representative CT slice. The difference was then calculated and compared between older generation computed tomography (OGCT; < 16 slices) and newer generation multidetector computed tomography (NGCT; ≥ 16 slices) using the Student t-test. A p value < .05 was considered significant. Forty-eight patients met our inclusion criteria. Of these, 20 were scanned with OGCT and 28 were scanned with NGCT. The mean peripheral point values...
The objective of this study was to examine the rates and geographic variation of endoscopic sinus... more The objective of this study was to examine the rates and geographic variation of endoscopic sinus surgery (ESS) in a representative sample of the US working population. Observational cohort study using the MarketScan Commercial Claim and Encounters database. All patients who received ESS between 2009 and 2013 were included. The annual adjusted rates of ESS per 1,000 people were calculated for each US state. Geographic variations were evaluated using the extremal quotient (EQ), weighted coefficient of variation (CV), systematic component of variance (SCV), and empirical Bayes statistic. The χ(2) statistic tests was used to quantify variation of the adjusted ESS rates across states within the US. The annual adjusted rate of ESS was 0.94 per 1,000 people in the US. South Dakota and Alabama were observed to have the highest rates of ESS, 1.80 and 1.69, respectively. Vermont and Arkansas were observed to have the lowest rates of ESS, 0.51 and 0.57, respectively. The mean EQ was 4.54, ind...
With the aim of facilitating preference-sensitive decision making regarding elective endoscopic s... more With the aim of facilitating preference-sensitive decision making regarding elective endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS), we set out to evaluate the predictive value of the 22-item Sinonasal Outcome Test (SNOT-22) patient-reported outcome measure and to compare outcomes of a UK cohort with a similar United States/Canadian-based study. Prospective observational cohort study, METHODS: Patients electing ESS in 87 UK hospitals were enrolled. The primary outcome was change in SNOT-22 score 3 months after surgery. Patients were categorized according to baseline SNOT-22 score, and the proportion of patients achieving a SNOT-22 minimal clinically important difference (MCID) of 8.9 was calculated, as well as the percentage change in SNOT-22 score. A total of 2,263 patients were included within this study. There was an average 40% reduction in SNOT-22 scores following surgery, and 66% of patients overall achieved the MCID. The proportion of patients achieving the MCID increased significantly with increasing baseline SNOT-22. Patients with a preoperative score of &amp;amp;amp;amp;amp;amp;amp;amp;lt;20 failed to achieve a mean improvement greater than the MCID. Patients with a score of &amp;amp;amp;amp;amp;amp;amp;amp;gt;30 had a greater than 70% chance of achieving the MCID. CRS patients with polyps had greater improvement than patients with CRS without polyps. The predictive value of the SNOT-22 is similar in the UK cohort, although overall patients did not benefit from surgery as much as their North American counterparts. Medically recalcitrant patients with CRS considering surgery should make decisions guided by their preoperative quality-of-life impairment, as measured by the SNOT-22. 2b Laryngoscope, 2015.
Intractable epistaxis is a common otolaryngology emergency. Transnasal endoscopic sphenopalatine ... more Intractable epistaxis is a common otolaryngology emergency. Transnasal endoscopic sphenopalatine artery ligation (TESPAL) and endovascular arterial embolization both provide excellent success rates, and therefore the decision to choose one over the other can be challenging. To aid in decision making by evaluating the cost-effectiveness of TESPAL vs endovascular arterial embolization for intractable epistaxis. Economic evaluation using a decision tree model with a 14-day time horizon for emergency department consultations for patients with intractable epistaxis defined as persistent bleeding despite bilateral anterior nasal packing. The economic perspective was the health care third-party payer. Effectiveness and probability data were obtained from the published medical literature. Costs were obtained from the published literature, the Centers for Medicare & Medicaid Services database, and the Healthcare Cost and Utilization Project database. Multiple sensitivity analyses were perfor...
The objective of this systematic review was to summarize the literature evaluating the costs asso... more The objective of this systematic review was to summarize the literature evaluating the costs associated with the management of adult chronic rhinosinusitis (CRS) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two separate authors systematically searched eight commonly used medical databases. Included articles were categorized into seven domains: 1) overall healthcare cost (direct and indirect), 2) resource utilization, 3) medical management strategies, 4) overall procedure cost of endoscopic sinus surgery (ESS), 5) intraoperative technologies, 6) ESS litigation, and 7) CRS diagnostics. To maintain a common currency for comparison, all costs were converted to 2014 United States dollars (USD) using an inflation calculator in September 2014. Forty-four studies were identified for inclusion. The range for overall CRS-related healthcare costs was $6.9 to $9.9 billion 2014 USD per year. Indirect costs were estimated as $13 billion 2014 USD per year. A...
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2014
To (1) evaluate the potential for recycling uncontaminated preoperative waste and (2) identify re... more To (1) evaluate the potential for recycling uncontaminated preoperative waste and (2) identify recycling differences within otolaryngology-head and neck surgery subspecialties. Prospective study. Three university-affiliated tertiary level hospitals. Otolaryngology-head and neck surgery operative procedures. A total of 97 operative procedures were evaluated. Preoperative waste products were sorted into recyclable and nonrecyclable materials; intraoperative waste was weighed for volume but not sorted. The preoperative period was defined as the opening of the surgical supply cart for operating room preparation until procedure initiation. Mass and volume of each type of waste were recorded upon the conclusion of the case. Approximately 23.1% of total operative waste mass (36.7% by volume) was derived from the preoperative set-up, of which 89.7% was recyclable. Pediatric procedures produced the least recyclable material per operation as a proportion of total waste, which was statisticall...
Off-label drug eluting middle-meatal spacers have shown promising results for improving clinical ... more Off-label drug eluting middle-meatal spacers have shown promising results for improving clinical outcomes following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). This study evaluates a dexamethasone Sinu-Foam™ spacer following ESS for CRS without nasal polyposis (CRSsNP). Patients with CRSsNP (n = 36) were enrolled into a double-blind, placebo-controlled trial and randomized into either a treatment arm (dexamethasone Sinu-Foam™ mixture; n = 18) or placebo arm (Sinu-Foam™ alone; n = 18). Therapeutic outcomes were evaluated at 1 week, 4 weeks, and 3 months using sinonasal endoscopy and graded using the Lund-Kennedy scoring system. Postoperative care included nasal saline irrigations and a short course of systemic steroids. All patients completed the study follow-up period. Both study arms experienced significant improvement in endoscopic grading over the study duration (p < 0.001). There was no difference in average endoscopic scores between the treatment and pla...
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2008
To evaluate the quality of meta-analyses written on otolaryngological topics and define areas tha... more To evaluate the quality of meta-analyses written on otolaryngological topics and define areas that can be improved upon in future studies. MEDLINE (PubMed) and EMBASE databases were searched. The Cochrane database of systematic reviews was excluded, because these meta-analyses have already been critically evaluated and found to be of high quality. A systematic review of otolaryngological meta-analyses published between 1997 and 2006 (10 years) was performed in duplicate and independently by two authors. The search included 16 common otolaryngological terms. Inclusion criteria were meta-analytic methodology, otolaryngological topic, and at least one author from a department of otolaryngology. Fifty-one articles fulfilled eligibility criteria. In duplicate and independently, two reviewers assessed the quality of eligible meta-analyses using a validated 10-item index called the Overview Quality Assessment Questionnaire. Using the methods of Spearman, correlation coefficients are report...
JAMA otolaryngology-- head & neck surgery, Jan 26, 2015
For patients with epistaxis in whom initial interventions, such as anterior packing and cauteriza... more For patients with epistaxis in whom initial interventions, such as anterior packing and cauterization, had failed, options including prolonged posterior packing, transnasal endoscopic sphenopalatine artery ligation (TESPAL), and embolization are available. However, it is unclear which interventions should be attempted and in which order. While cost-effectiveness analyses have suggested that TESPAL is the most responsible use of health care resources, physicians must also consider patient risk to maintain a patient-centered decision-making process. To quantify the risk associated with the management of intractable epistaxis. A risk analysis was performed using literature-reported probabilities of treatment failure and adverse event likelihoods in an emergency department and otolaryngology hospital admissions setting. The literature search included articles from 1980 to May 2014. The analysis was modeled for a 50-year-old man with no other medical comorbidities. Severities of complica...
The primary objective of this pilot study was to define the change in productivity costs followin... more The primary objective of this pilot study was to define the change in productivity costs following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Secondary objectives were to identify CRS-related characteristics that may influence the degree of productivity improvement after ESS. Prospective, multi-institutional, observational cohort study. The human capital approach was used to define productivity costs. Annual absenteeism, presenteeism, and lost leisure time were quantified to define annual lost productive time (LPT). LPT was monetized using the annual daily wage rates obtained from the 2012 US Census and the 2013 US Department of Labor statistics. Twenty-seven patients with refractory CRS who underwent ESS were followed for a mean of 15 months (range, 8-25 months). Following ESS, there were improvements in annual absenteeism (22 days reduced to 3 days), annual presenteeism (41 days reduced to 19 days), and annual household days lost (12 days reduced to 6 days). ...
International forum of allergy & rhinology, Jan 3, 2015
A health utility value represents an individual's preference for living in a specific health ... more A health utility value represents an individual's preference for living in a specific health state and is used in cost-utility analyses. This study investigates the impact of continuing medical therapy on health utility outcomes in patients with chronic rhinosinusitis (CRS). The Medical Outcomes Study Short Form-6D (SF-6D) questionnaire was administered to patients prospectively enrolled in a longitudinal study examining treatment outcomes for CRS. Patients were prescribed robust, initial medical therapy and then elected to continue with medical therapy (n = 40) or undergo endoscopic sinus surgery (ESS), followed by medical therapy (n = 152). Patients observed through treatment crossover to ESS were also evaluated (n = 20). Health utility values (SF-6D) were generated at baseline, 6-months, and 12-months follow-up for both cohorts and evaluated using repeated measures analysis of variance (ANOVA). Treatment crossover patients were found to have a significantly higher prevalence ...
Canadian journal of surgery. Journal canadien de chirurgie
The use of complementary and alternative medicine (CAM) is becoming more common, particularly amo... more The use of complementary and alternative medicine (CAM) is becoming more common, particularly among cancer patients. We sought to define the frequency of CAM use among general surgery, hepatobiliary and surgical oncology patients and to define some of the determinants of CAM use in patients with benign and malignant disease. We asked all patients attending the clinics of 3 hepatobiliary/surgical oncology surgeons from 2002 to 2005 to voluntarily respond on first and subsequent visits to a questionnaire related to the use of CAM. We randomly selected patients for review. We reviewed a total of 490 surveys from 357 patients. Overall CAM use was 27%. There was significantly more CAM use among cancer (34%) versus noncancer patients (21%; p = 0.008), and the use of CAM was more common in patients with unresectable cancer (51%) than resectable cancer (22%; p < 0.001). There was no significant difference in use between men and women. There did not appear to be a change in CAM use with p...
To evaluate the cost-effectiveness of transoral robotic surgery (TORS) compared to intensity-modu... more To evaluate the cost-effectiveness of transoral robotic surgery (TORS) compared to intensity-modulated radiotherapy (IMRT) for early stage (T1-2, N0, M0) oropharyngeal squamous cell carcinoma (OPSCC). A Markov decision tree model with a 5-year time horizon was developed. Comparative groups were: i) TORS with concurrent ipsilateral neck dissection +/- adjunctive IMRT, and ii) primary IMRT. Primary outcome was cost/quality adjusted life year (QALY). Perspective was the United States third party payer. Costs and effects were discounted at a rate of 3.5%. A threshold and probabilistic sensitivity analysis were performed. TORS strategy cost $30,992 and provided 4.81 QALYs/patient. The IMRT strategy cost $26,033 and provided a total of 4.78 QALYs/patient. The incremental cost effectiveness ratio for TORS vs. IMRT in the reference case was $165,300/QALY. The probability that TORS is cost-effective compared to IMRT at a maximum willingness-to-pay threshold of $50,000/QALY is 42%. An IMRT st...
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
Rhinology, which encompasses clinical and surgical treatment of the nasal cavity and paranasal si... more Rhinology, which encompasses clinical and surgical treatment of the nasal cavity and paranasal sinuses, is a growing subspecialty with advances in the surgical, clinical, and research realms. The advancement of this subspecialty and its impact on the practice of otolaryngology, in both academic and nonacademic institutions, is not yet understood. A novel survey created by our research team was mailed out to 150 randomly selected otolaryngology staff and 8 fellowship-trained rhinologists throughout Canada asking questions related to demographics, training, referral patterns, technique, and adequacy of training. One hundred respondents completed the survey, yielding a response rate of 63%. The average age of rhinologists who responded (38 years) was younger than those who were nonrhinologists (50 years). Compared with fellowship-trained rhinologists, nonrhinologists felt less comfortable with cerebrospinal leak repairs, skull base surgery, frontal sinus surgery, paranasal sinus neopla...
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
To understand how newer generation multidetector computed tomographic (NGCT) scanner technology (... more To understand how newer generation multidetector computed tomographic (NGCT) scanner technology (≥ 16 slices) has affected the imaging characteristics of head and neck abscesses. Retrospective chart review.Setting:Tertiary referral centre. Forty-eight patients with a head and neck abscess who underwent a soft tissue neck computed tomographic (CT) scan were identified from September 1, 2001, to December 1, 2008. The degree of rim enhancement, delta (Δ), was graded using mean Hounsfield units (HU) from five peripheral points and five central points from a representative CT slice. The difference was then calculated and compared between older generation computed tomography (OGCT; < 16 slices) and newer generation multidetector computed tomography (NGCT; ≥ 16 slices) using the Student t-test. A p value < .05 was considered significant. Forty-eight patients met our inclusion criteria. Of these, 20 were scanned with OGCT and 28 were scanned with NGCT. The mean peripheral point values...
The objective of this study was to examine the rates and geographic variation of endoscopic sinus... more The objective of this study was to examine the rates and geographic variation of endoscopic sinus surgery (ESS) in a representative sample of the US working population. Observational cohort study using the MarketScan Commercial Claim and Encounters database. All patients who received ESS between 2009 and 2013 were included. The annual adjusted rates of ESS per 1,000 people were calculated for each US state. Geographic variations were evaluated using the extremal quotient (EQ), weighted coefficient of variation (CV), systematic component of variance (SCV), and empirical Bayes statistic. The χ(2) statistic tests was used to quantify variation of the adjusted ESS rates across states within the US. The annual adjusted rate of ESS was 0.94 per 1,000 people in the US. South Dakota and Alabama were observed to have the highest rates of ESS, 1.80 and 1.69, respectively. Vermont and Arkansas were observed to have the lowest rates of ESS, 0.51 and 0.57, respectively. The mean EQ was 4.54, ind...
With the aim of facilitating preference-sensitive decision making regarding elective endoscopic s... more With the aim of facilitating preference-sensitive decision making regarding elective endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS), we set out to evaluate the predictive value of the 22-item Sinonasal Outcome Test (SNOT-22) patient-reported outcome measure and to compare outcomes of a UK cohort with a similar United States/Canadian-based study. Prospective observational cohort study, METHODS: Patients electing ESS in 87 UK hospitals were enrolled. The primary outcome was change in SNOT-22 score 3 months after surgery. Patients were categorized according to baseline SNOT-22 score, and the proportion of patients achieving a SNOT-22 minimal clinically important difference (MCID) of 8.9 was calculated, as well as the percentage change in SNOT-22 score. A total of 2,263 patients were included within this study. There was an average 40% reduction in SNOT-22 scores following surgery, and 66% of patients overall achieved the MCID. The proportion of patients achieving the MCID increased significantly with increasing baseline SNOT-22. Patients with a preoperative score of &amp;amp;amp;amp;amp;amp;amp;amp;lt;20 failed to achieve a mean improvement greater than the MCID. Patients with a score of &amp;amp;amp;amp;amp;amp;amp;amp;gt;30 had a greater than 70% chance of achieving the MCID. CRS patients with polyps had greater improvement than patients with CRS without polyps. The predictive value of the SNOT-22 is similar in the UK cohort, although overall patients did not benefit from surgery as much as their North American counterparts. Medically recalcitrant patients with CRS considering surgery should make decisions guided by their preoperative quality-of-life impairment, as measured by the SNOT-22. 2b Laryngoscope, 2015.
Intractable epistaxis is a common otolaryngology emergency. Transnasal endoscopic sphenopalatine ... more Intractable epistaxis is a common otolaryngology emergency. Transnasal endoscopic sphenopalatine artery ligation (TESPAL) and endovascular arterial embolization both provide excellent success rates, and therefore the decision to choose one over the other can be challenging. To aid in decision making by evaluating the cost-effectiveness of TESPAL vs endovascular arterial embolization for intractable epistaxis. Economic evaluation using a decision tree model with a 14-day time horizon for emergency department consultations for patients with intractable epistaxis defined as persistent bleeding despite bilateral anterior nasal packing. The economic perspective was the health care third-party payer. Effectiveness and probability data were obtained from the published medical literature. Costs were obtained from the published literature, the Centers for Medicare & Medicaid Services database, and the Healthcare Cost and Utilization Project database. Multiple sensitivity analyses were perfor...
The objective of this systematic review was to summarize the literature evaluating the costs asso... more The objective of this systematic review was to summarize the literature evaluating the costs associated with the management of adult chronic rhinosinusitis (CRS) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two separate authors systematically searched eight commonly used medical databases. Included articles were categorized into seven domains: 1) overall healthcare cost (direct and indirect), 2) resource utilization, 3) medical management strategies, 4) overall procedure cost of endoscopic sinus surgery (ESS), 5) intraoperative technologies, 6) ESS litigation, and 7) CRS diagnostics. To maintain a common currency for comparison, all costs were converted to 2014 United States dollars (USD) using an inflation calculator in September 2014. Forty-four studies were identified for inclusion. The range for overall CRS-related healthcare costs was $6.9 to $9.9 billion 2014 USD per year. Indirect costs were estimated as $13 billion 2014 USD per year. A...
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2014
To (1) evaluate the potential for recycling uncontaminated preoperative waste and (2) identify re... more To (1) evaluate the potential for recycling uncontaminated preoperative waste and (2) identify recycling differences within otolaryngology-head and neck surgery subspecialties. Prospective study. Three university-affiliated tertiary level hospitals. Otolaryngology-head and neck surgery operative procedures. A total of 97 operative procedures were evaluated. Preoperative waste products were sorted into recyclable and nonrecyclable materials; intraoperative waste was weighed for volume but not sorted. The preoperative period was defined as the opening of the surgical supply cart for operating room preparation until procedure initiation. Mass and volume of each type of waste were recorded upon the conclusion of the case. Approximately 23.1% of total operative waste mass (36.7% by volume) was derived from the preoperative set-up, of which 89.7% was recyclable. Pediatric procedures produced the least recyclable material per operation as a proportion of total waste, which was statisticall...
Off-label drug eluting middle-meatal spacers have shown promising results for improving clinical ... more Off-label drug eluting middle-meatal spacers have shown promising results for improving clinical outcomes following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). This study evaluates a dexamethasone Sinu-Foam™ spacer following ESS for CRS without nasal polyposis (CRSsNP). Patients with CRSsNP (n = 36) were enrolled into a double-blind, placebo-controlled trial and randomized into either a treatment arm (dexamethasone Sinu-Foam™ mixture; n = 18) or placebo arm (Sinu-Foam™ alone; n = 18). Therapeutic outcomes were evaluated at 1 week, 4 weeks, and 3 months using sinonasal endoscopy and graded using the Lund-Kennedy scoring system. Postoperative care included nasal saline irrigations and a short course of systemic steroids. All patients completed the study follow-up period. Both study arms experienced significant improvement in endoscopic grading over the study duration (p < 0.001). There was no difference in average endoscopic scores between the treatment and pla...
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2008
To evaluate the quality of meta-analyses written on otolaryngological topics and define areas tha... more To evaluate the quality of meta-analyses written on otolaryngological topics and define areas that can be improved upon in future studies. MEDLINE (PubMed) and EMBASE databases were searched. The Cochrane database of systematic reviews was excluded, because these meta-analyses have already been critically evaluated and found to be of high quality. A systematic review of otolaryngological meta-analyses published between 1997 and 2006 (10 years) was performed in duplicate and independently by two authors. The search included 16 common otolaryngological terms. Inclusion criteria were meta-analytic methodology, otolaryngological topic, and at least one author from a department of otolaryngology. Fifty-one articles fulfilled eligibility criteria. In duplicate and independently, two reviewers assessed the quality of eligible meta-analyses using a validated 10-item index called the Overview Quality Assessment Questionnaire. Using the methods of Spearman, correlation coefficients are report...
JAMA otolaryngology-- head & neck surgery, Jan 26, 2015
For patients with epistaxis in whom initial interventions, such as anterior packing and cauteriza... more For patients with epistaxis in whom initial interventions, such as anterior packing and cauterization, had failed, options including prolonged posterior packing, transnasal endoscopic sphenopalatine artery ligation (TESPAL), and embolization are available. However, it is unclear which interventions should be attempted and in which order. While cost-effectiveness analyses have suggested that TESPAL is the most responsible use of health care resources, physicians must also consider patient risk to maintain a patient-centered decision-making process. To quantify the risk associated with the management of intractable epistaxis. A risk analysis was performed using literature-reported probabilities of treatment failure and adverse event likelihoods in an emergency department and otolaryngology hospital admissions setting. The literature search included articles from 1980 to May 2014. The analysis was modeled for a 50-year-old man with no other medical comorbidities. Severities of complica...
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Papers by Luke Rudmik