Current practices in venous thromboembolism prophylaxis in otolaryngology-head and neck surgery.

BACKGROUND: There has been recent investigation into the incidence of venous thromboembolism in otolaryngology, but the current utilization of venous thromboembolic (VTE) prophylaxis among practicing otolaryngologists remains largely unknown. METHODS: A survey of 26 questions was emailed to 4376 otolaryngologists. RESULTS: A total of 4376 surveys were sent and 676 were returned for a response rate of 15.4%. Intraoperative prophylaxis was used by 535 respondents (83%), either with intermittent pneumatic compression (91.8%), compression stockings (35.9%), or low-molecular-weight heparin (LMWH; 12.3%). Postoperative prophylaxis was used by 540 respondents (85.4%), either with early ambulation (87.8%), intermittent pneumatic compression (85.4%), compression stockings (43.3%), or LMWH (42.4%). The vast majority (88.3%) stated they would find thromboprophylaxis guidelines released by the American Academy of Otolaryngology - Head and Neck Surgery to be helpful. CONCLUSION: Current practices in venous thromboembolism prophylaxis vary widely among the otolaryngology community. A set of clear specialty-specific guidelines may be helpful. © 2015 Wiley Periodicals, Inc. Head Neck 38: E341-E345, 2016.

Characteristics of patients undergoing supraglottoplasty for laryngomalacia.

OBJECTIVE: To examine the characteristics of patients undergoing supraglottoplasty for the treatment of laryngomalacia and to better understand the features of laryngomalacia that may predispose patients to the need for supraglottoplasty. METHODS: Review of patients who underwent supraglottoplasty for laryngomalacia at our academic tertiary care children's hospital between 2005 and 2012 examining demographic information, medical comorbidities, symptoms, indications for surgery, operative findings and procedure, site of laryngeal obstruction, operative techniques, and surgical success rates. RESULTS: Seventeen patients with laryngomalacia underwent nineteen procedures. The most common indications for supraglottoplasty were persistent stridor beyond 18 months of age (64.7%), difficulty feeding (47%), and failure to thrive (29.4%). The most common comorbidities were gastroesophageal reflux (88.2%) and cardiopulmonary disease (35.3%). Operative findings included shortened aryepiglottic folds in sixteen patients (94.1%), retropositioned epiglottis in sixteen (94.1%), and prolapsed arytenoid mucosa in five (29.4%). Fifteen patients (88.2%) underwent division of the aryepiglottic folds and four underwent ablation of arytenoid mucosa (23.5%). Of the seventeen patients who had followed up at the time of study conclusion, sixteen (94.1%) had symptom improvement and twelve (70.6%) had complete resolution of their symptoms. CONCLUSIONS: Supraglottoplasty is an effective treatment for laryngomalacia. Outcomes in our patients are similar to those reported in prior literature. The findings of shortened aryepiglottic folds and a retropositioned epiglottis appear to be disproportionately represented in our cohort of patients undergoing supraglottoplasty.

Collaborating to increase access to clinical and educational resources for surgery: a case study.

A case study is described in which collaborations between a Department of Surgery, a Department of Information Technology, and an academic health sciences library resulted in the development of an electronic surgical library available at the bedside, the deployment of tablet devices for surgery residents, and implementation of a tablet-friendly user interface for the institution's electronic medical record.

Incidence of venous thromboembolism in otolaryngology-head and neck surgery.

OBJECTIVE: To examine the incidence of venous thromboembolic disease in the otolaryngology-head and neck surgery (OTO-HNS) patient population. DESIGN, SETTING, AND PATIENTS: Review of medical records for all patients undergoing a surgical procedure during fiscal years 2008 to 2011 (July 1, 2008, through June 30, 2011) at an academic tertiary care medical center. INTERVENTION: A total of 59 884 total surgical procedures among all the surgical services. MAIN OUTCOME MEASURES: The incidence of deep venous thrombosis and pulmonary embolism. RESULTS: There were 5616 otolaryngology procedures performed during the study period. Clinically evident deep venous thrombosis developed in 3 patients; 2 of these patients also developed a pulmonary embolism. The overall incidence of deep venous thrombosis and pulmonary embolism in OTO-HNS was 0.05% and 0.035%, respectively. All patients who developed deep venous thrombosis or a pulmonary embolism in the OTO-HNS population were inpatients being treated for cancer. There were no deep venous thromboses or pulmonary emboli in patients undergoing same-day or overnight surgery or in patients without an active cancer. The OTO-HNS service had significantly lower rates of venous thromboembolism than did most other surgical specialties despite lower rates of adherence to venous thromboembolism prophylaxis guidelines. CONCLUSIONS: The incidence of deep venous thrombosis and pulmonary embolism among the OTO-HNS patient population at our academic center is lower than the incidence reported in previous studies (range, 0.1%-0.3%) and is significantly lower than the incidence observed in other surgical specialties. It is likely that patient- and specialty-specific factors as well as the more aggressive use of venous thromboembolism prophylaxis during recent years are at least partially responsible for the decreased incidence in our population.

Successful telemedicine programs in otolaryngology.

This article discusses the types of telemedicine technologies that are currently in place and being used successfully in otolaryngology. It examines how these technologies have been applied in several different otolaryngology telemedicine programs and discusses their relative merits and successes.