ABSTRACT
Angioplasty and stent placement have become accepted alternatives to surgery in many vascular territories. The most recent application of percutaneous intervention has been to explore its clinical utility and safety for stroke prevention in carotid arteries. Over the past 8 years, from January 1994 until Nov 2002, we performed 449 elective carotid stent procedures in 426 patients and in 481 vessels. Informed consent was obtained from each patient. Success was achieved in 97.3% of the patients treated. After one month of follow-up, 12 (2.8%) patients experienced stroke or death. After an average of 2.8 ± 1.7 years (range 1 month to 8.8 years) of follow-up, restenosis was found in 11 (2.6%) patients and was treated with balloon angioplasty. Our results, in a predominantly high-risk surgery group of patients, suggest that carotid stent placement is a viable treatment alternative to conventional surgery. It is likely that as the technology continues to evolve, the procedural risks of stroke and death will be minimized by embolic protection devices, making carotid stenting an option for low-risk surgical patients.
ABSTRACT
BACKGROUND: Outpatient tympanomastoidectomy is common in many medical centers. However, failure of same-day discharge is often the result of postoperative nausea and vomiting (PONV). Many times this leads to hospital admission after tympanomastoidectomy, and it is often difficult to predict before surgery whether PONV will be an issue that impedes same-day discharge. OBJECTIVE: To determine the clinical factors correlated with the incidence of PONV requiring hospital admission after chronic ear surgery by hypothesizing that the complexity of a particular case, as measured using a 10-point scale, is predictive of surgical time or failure of same-day hospital discharge. STUDY DESIGN: Retrospective medical chart review of 103 patients having mastoidectomy with tympanoplasty for chronic otitis media over a 2-year period. METHODS: We recorded patient age, clinical data, surgical times, types of agents used for induction and maintenance of anesthesia, use of prophylactic antiemetic drugs, types and doses of analgesic agents, and PONV. Univariate and multivariate logistic regression analyses were performed to determine which variables were associated with PONV that required hospital admission. RESULTS: One third of patients studied were safely discharged from the hospital the day of surgery, and 92% were discharged within 23 hours. The most common cause for observation admission to the hospital was PONV. The only variable in multivariate analysis that significantly correlated with PONV mandating hospital admission after tympanomastoid surgery was a history of motion sickness or PONV (odds ratio, 5.21; P =.02). Although severity of disease did not correlate with length of hospital stay, it directly correlated with length of surgery. CONCLUSIONS: A history of PONV or motion sickness is predictive of PONV and length of hospital stay. Routine planning for a 23-hour overnight observation stay seems warranted for all patients undergoing tympanomastoidectomy, despite severity of disease.
