Satisfaction in Academic Otolaryngology: Do Physician Demographics Impact Press Ganey Survey Scores?

OBJECTIVES/HYPOTHESIS: Patient satisfaction is increasingly emphasized and measured in healthcare delivery. However, patient satisfaction is multifactorial and difficult to comprehensively assess. The objective of this study was to assess for correlation between patient satisfaction measured by Press Ganey surveys (PGS) and physician demographics of gender, years in practice, academic rank, and specialty in academic otolaryngology. STUDY DESIGN: Review of publicly available PGS scores in academic otolaryngology practice. METHODS: Public websites of academic otolaryngology departments were assessed for inclusion of PGS scores. Individual physician profiles were queried for years in practice, academic rank, and specialty. Gender was determined by picture or profile pronouns. Univariate and multivariate analyses compared PGS scores with studied variables. RESULTS: Forty-seven of 113 (42.8%) academic practices publicly reported physician PGS score. Of 1,360 affiliated otolaryngologists, 742 (54.6%,592 male:150 female) revealed PGS scores. Average PGS score for male and female providers was equivalent (PGS = 4.73, P = .84). There was no significant difference in PGS scores by academic rank (P = .28). A weak statistically significant decrease in mean PGS scores was associated with longer duration of practice (r = -0.11, P = .018). Head and neck oncologic surgeons had higher mean PGS score in comparison to other specialties (PGS = 4.81, P < .05). General/comprehensive otolaryngologists had lower average PGS score (PGS = 4.66) in comparison to specialists (P < .05). CONCLUSIONS: Physician gender and academic rank do not correlate with patient satisfaction in academic otolaryngology as measured by publicly reported PGS scores. Head and neck oncology is rated more highly than other specialties, and physicians in practice for longer demonstrate decreased PGS scores. With PGS scores tied to physician evaluation and reimbursement, investigation into the generalizability of PGS in otolaryngology is warranted. LEVEL OF EVIDENCE: NA Laryngoscope, 130: 1902-1906, 2020.

Reconstructive Techniques for the Saddle Nose Deformity in Granulomatosis With Polyangiitis: A Systematic Review.

Importance: Repairing the saddle nose deformity in the setting of granulomatosis with polyangiitis disease is a rare but challenging situation for any surgeon. Given that the available data in the literature is based on case reports and small case series, there is little evidence available to help delineate which reconstructive techniques are optimal. Objective: To examine which techniques were most successful in reconstructive rhinoplasty for a saddle nose deformity secondary to granulomatosis with polyangiitis. Evidence Review: PubMed, MEDLINE, Cochrane Collaboration Databases, and Web of Science were searched using the terms Wegener's granulomatosis or granulomatosis with polyangiitis cross-referenced with saddle nose deformity or acquired nasal deformity. These databases were supplemented with 2 cases from Boston Medical Center. Databases were queried from inception of article collection through December 14, 2015, to identify publications reporting the repair of a saddle nose deformity and granulomatosis with polyangiitis. Findings: A total of 10 studies met inclusion criteria yielding a cohort of 44 patients. The overall success rate for rhinoplasty, both primary and secondary, was 84.1% (37 of 44 patients), with a complication rate of 20%. The use of a single L-shaped graft fared better than individually placed grafts. An increased risk of graft failure was noted as the number of overall grafts increased and if nonautologous tissue was used. Conclusions and Relevance: Rhinoplasty for saddle nose deformity is a safe and effective procedure in the setting of granulomatosis with polyangiitis. In the face of this disease, reconstruction should focus on placing a robust, L-shaped strut graft with autologous tissue over individual grafts. Additionally, the use of split-calvarial bone appears to have a slightly lower complication rate over costal cartilage.