The Laryngoscope
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To identify the association between surgeon/hospital volume with outcomes in surgical treatment for obstructive sleep apnea (OSA) in a nationally representative sample. We hypothesized that surgeons/hospitals with lower patient volumes would have: higher mortality rates, longer hospital length of stay (LOS), and higher postoperative complication rates and hospitalization charges. ⋯ Our investigation validates the hypothesis that lower volume standards (surgeon/hospital) are associated with increase of LOS following surgery to treat OSA, as well as lower surgeon volume associated with increase of mortality and hospitalization charges and lower hospital volume with occurrence of oxygen desaturation as postoperative complication.
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Observational Study
Whose experience is measured? A pilot study of patient satisfaction demographics in pediatric otolaryngology.
Despite a national emphasis on patient-centered care and cultural competency, minority and low-income children continue to experience disparities in health care quality. Patient satisfaction scores are a core quality indicator. The objective of this study was to evaluate race and insurance-related disparities in parent participation with pediatric otolaryngology satisfaction surveys. ⋯ Methods to evaluate satisfaction did not capture the racial or socioeconomic patient distribution within this pediatric division. These findings challenge the validity of applying patient satisfaction scores, as currently measured, to indicate health care quality. Future efforts to measure and improve patient experience should be inclusive of a culturally diverse population.
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To determine if tympanic membrane perforation offers any protection from inner ear damage and determine the incidence and pattern of otologic blast injury in military personnel returning from deployment. ⋯ Due to its violent nature, blast exposure causes greater neuro-otological manifestations and deserves prompt otologic evaluation.
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Comparative Study
Perioperative process errors and delays in otolaryngology at a Veterans Hospital: prospective study.
To understand the leading causes for process errors and delays in the otolaryngology operating room and recognize the impact of process errors and delays on patient safety, operating room resources and hospital costs. ⋯ Process errors and significant delays were common in cases performed at our institution; communication errors were the most common etiology. There is opportunity for preoperative team discussion and the use of technology to minimize communication-related process errors and standstill delays. Further work is currently being undertaken to study this critical issue across specialties.
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Randomized Controlled Trial Comparative Study
Effect-site concentration of remifentanil to prevent cough after laryngomicrosurgery.
The aim of this study was to discover the optimal effect-site concentration of remifentanil for cough prevention that does not delay awakening or cause respiratory depression during emergence from anesthesia with propofol and remifentanil in laryngomicrosurgery patients. ⋯ Maintenance of remifentanil at Ce 1.5 and 2 ng/mL suppressed coughing without serious adverse events during emergence from anesthesia with propofol and remifentanil in patients undergoing laryngomicrosurgery.