In-office vs. operating room procedures for recurrent respiratory papillomatosis.

We conducted a study to analyze hospital and patient costs, outcomes, and patient satisfaction among adults undergoing in-office and operating room procedures for the treatment of recurrent respiratory papillomatosis. Our final study population was made up of 17 patients-1 man and 16 women, aged 30 to 86 years (mean: 62). The mean number of in-office laser procedures per patient was 4.2, and the mean interval between procedures was 5.4 months (although 10 patients underwent only 1 office procedure); the mean number of operating room procedures was 13.5, and the mean interval between procedures was 14.3 months. An equal number of patients reported complications or adverse events with the two types of procedures-5 each. The difference in cost between the office procedure (mean: $3,413.00) and the operating room procedure (mean: $12,382.59) was almost $9,000, but these savings were offset by the fact that the office procedures needed to be performed three times as often. Patients reported slightly more anxiety and discomfort during the office procedures and, overall, they appeared to prefer the operating room procedure. We conclude that office procedures are significantly more cost-effective than operating room procedures, but their use may be limited by patient tolerance and the increased frequency of the procedure.

Bleeding risk associated with resection of the middle turbinate during functional endoscopic sinus surgery.

BACKGROUND: The decision to resect the middle turbinate (MT) during functional endoscopic sinus surgery is controversial. Although there have been a variety of studies that examined the functional outcome related to this maneuver, very few studies evaluated the potential for complications, in particular, epistaxis. OBJECTIVE: We sought to determine if resection of the MT during functional endoscopic sinus surgery leads to an increased risk for postoperative bleeding. METHODS: Patients who underwent functional endoscopic sinus surgery for chronic sinusitis or nasal polyposis between 2004 and 2014 at a single institution were analyzed for bleeding and other complications after resection of the MT. RESULTS: Between 2004 and 2014, 1185 sinus surgeries were performed by 18 surgeons. A propensity matched set of 228 patients who underwent turbinate resection, and 228 controls were selected based on predicted probabilities from a logistic regression that predicted turbinate resection and that was adjusted for age, sex, and procedure. There were 89 patients with bilateral turbinates removed and 139 with unilateral turbinates removed. There was no significant difference in major bleeding or other complication rates between the two groups. Patients who underwent resection of at least one MT were 3.95 times more likely to have minor bleeding compared with those who did not; this risk increased with the number of turbinates resected (trend p = 0.008). Patients on anticoagulation medications were at a significant risk of bleeding if their MT was removed (p = 0.007), whereas patients on aspirin or antiplatelet therapy were not at a significant risk. CONCLUSION: There was no increased risk of major bleeding or other complication associated with resection of the MT. However, there was a significantly increased minor bleeding rate associated with MT resection, particularly if the patient was on anticoagulants.

Predictors of repeated "no-showing" to clinic appointments.

OBJECTIVE: To determine the variables that contribute to repeated patient non-compliance with showing up to clinic appointments. STUDY DESIGN: Retrospective chart review. SETTING: Single tertiary care academic institution. SUBJECTS AND METHODS: Patients who did not show up to 3 or more clinic appointments in the otolaryngology department in the Henry Ford Health System in metro Detroit, Michigan between July 1, 2011 to June 30, 2012 area were compared to control patients randomly chosen from those who had appointments on the same day with the same provider as the no-show patients. RESULTS: 105 patients were identified who no-showed to 3 or more clinic appointments. Younger age, black race, and lower income were all found to be significant factors for patients missing appointments in a multiple variate model. On logistic regression, Medicaid insurance, closer distance from home to appointment, less bus transfers, and less time by bus travel were also found to correlate with no-showing. CONCLUSION: Age, race, and income are significantly related to patient non-compliance with clinic appointments. Paradoxically, proximity to the clinical appointment location is also significantly related - we hypothesize this may be the result of significant income inequality in the metro Detroit population distribution. Follow up studies include analyzing factors that precluded patient access and interventions to improve compliance and decrease cost.