Survey of endoscopic skull base surgery practice patterns among otolaryngologists

Wannemuehler, Todd J.; Rabbani, Cyrus C.; Burgeson, Jack E.; Illing, Elisa A.; Walgama, Evan; Wu, Arthur W.; Ting, Jonathan Y.

doi:10.1002/lio2.149

Cited by 15 publications

(25 citation statements)

References 48 publications

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“…To date, there are only retrospective analyses and expert opinion on the risks and recommended best practice for CPAP use after endonasal surgery. [4][5][6] While the pressure supplied by CPAP machines can be controlled and titrated to treat OSA, there have been no studies to date analyzing pressures specifically transmitted to the nasal cavity, paranasal sinuses, or skull base. The goals of this study are to demonstrate the safety of this sensor technology, to validate our cadaveric model in vivo, and to quantify the effect of positive pressure ventilation on the human nasal cavity where physiologic factors such as mucosal edema, secretions, and lung compliance are present.…”

Section: Introductionmentioning

confidence: 99%

Qualitative Assessment of the Effect of Continuous Positive Airway Pressure on the Nasal Cavity

Reilly

Huntley

Boon

et al. 2020

Am J Rhinol�Allergy

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Background For patients with obstructive sleep apnea (OSA), there is a lack of knowledge regarding the impact of continuous positive airway pressure (CPAP) on the nasal cavity. There is a significant need for evidence-based recommendations regarding the appropriate use of CPAP following endoscopic sinus and skull base surgery. Objective The goal of this study is to translate a previously developed cadaveric model for evaluating CPAP pressures in the sinonasal cavity by showing safety in vivo and quantifying the effect of positive pressurized air flow on the nasal cavity of healthy individuals where physiologic effects are at play. Methods A previously validated cadaveric model using intracranial sensor catheters has proved to be a reliable technique for measuring sinonasal pressures. These sensors were placed in the nasal cavity of 18 healthy individuals. Pressure within the nose was recorded at increasing levels of CPAP. Results Overall, nasal cavity pressure was on average 85% of delivered CPAP. The amount of pressure delivered to the nasal cavity increased as the CPAP increased. The percentage of CPAP delivered was 77% for 5 cmH2O and increased to 89% at 20 cmH2O. There was a significant difference in mean intranasal pressures between all the levels of CPAP except 5 cmH2O and 8 cmH2O ( P < .001). Conclusion On average, only 85% of the pressure delivered by CPAP is transmitted to the nasal cavity. Higher CPAP pressures delivered a greater percentage of pressurized air to the nasal cavity floor. Our results are comparable to the cadaver model, which demonstrated similar pressure delivery even in the absence of anatomic factors such as lung compliance, nasal secretions, and edema. This study demonstrates the safety of using sensors in the human nasal cavity. This technology can also be utilized to evaluate the resiliency of various repair techniques for endoscopic skull base surgery with CPAP administration.

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Section: Introductionmentioning

confidence: 99%

Qualitative Assessment of the Effect of Continuous Positive Airway Pressure on the Nasal Cavity

Reilly

Huntley

Boon

et al. 2020

Am J Rhinol�Allergy

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“…There is little data describing the indications of ESBS due to disparate current procedural terminology (CPT) coding practices. 12 The particular proportions of lesion location and approaches may have implications on the uncovered risk factors. However, given the concordance of our findings with research from other surgical subspecialties, it is probable that these patient-level factors are implicated in persistent opioid use following ESBS.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Surveys into postprocedural practices have yielded insight into surgeon preferences for postoperative imaging, patient restrictions, and postoperative level of care. 11,12 There remains a significant gap in the understanding and description of pain management regimens, and little insight into factors predictive of greater postoperative opioid requirement.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Predictive Factors for Additional Opioid Prescription after Endoscopic Skull Base Surgery

Shen

Jafari

Qualliotine

et al. 2019

J Neurol Surg B Skull Base

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Introduction Postoperative pain management and opioid use following endoscopic skull base surgery (ESBS) is not well understood. A subset of patients requires additional opioid prescription (AOP) in the postoperative period. The objective of this study is to describe the incidence of AOP, as well as evaluate patient and surgical characteristics that may predict additional pain management requirements following ESBS. Methods A retrospective review of cases undergoing ESBS between November 2016 and August 2018 was performed. We reviewed patients' sociodemographic and clinical data, and Controlled Substance Utilization Review and Evaluation System (CURES) records. Stepwise multivariable logistic regressions were performed to evaluate the factors associated with AOP within 60 days following surgery. Results A total of 42 patients were identified. Indications for ESBS included intracranial mass (64.2%), sinonasal malignancy (23.8%), and skull base reconstruction (9.5%). AOP were recorded in nine patients (21.4%). There were no significant differences in operative factors, including approach, lesion location, or perioperative analgesia between the two cohorts. On multivariable logistic regression, we found that younger age (odds ratio [OR]: 0.891, 95% confidence interval [CI]: 0.79–1.00, p = 0.050), comorbid depression (OR: 86.48, 95% CI: 1.40–5,379.07, p = 0.034), and preoperative opioid use (OR: 104.45, 95% CI: 1.41–7,751.10, p = 0.034) were associated with additional prescriptions postoperatively. Conclusion The requirement for extended postoperative opioid pain control is common after ESBS. Patient demographics including age and psychosocial factors, such as depression may predict the need for AOP after ESBS. These results suggest that patient-driven factors, rather than surgical characteristics, may determine the need for prolonged pain control requirements after ESBS.

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“…There are currently no evidence‐based recommendations regarding the risks and optimal timing of CPAP reinitiation after sinonasal surgery. To date, there are only retrospective analyses and expert opinion on the recommended best practice regarding CPAP use following endonasal surgery 3–5 . Furthermore, the decision of when to restart CPAP is typically surgeon‐dependent, and as a result, varies greatly amongst practitioners.…”

Section: Introductionmentioning

confidence: 99%

“…To date, there are only retrospective analyses and expert opinion on the recommended best practice regarding CPAP use following endonasal surgery. [3][4][5] Furthermore, the decision of when to restart CPAP is typically surgeon-dependent, and as a result, varies greatly amongst practitioners. The goal of this study was to assess the tolerability of restarting CPAP on postoperative day 1 following septoplasty/ turbinectomy or functional endoscopic sinus surgery (FESS).…”

Section: Introductionmentioning

confidence: 99%

Tolerance of Continuous Positive Airway Pressure After Sinonasal Surgery

et al. 2020

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Objectives/Hypothesis For patients with obstructive sleep apnea (OSA) undergoing sinonasal surgery, there is a lack of consensus on the risk and appropriate postoperative use of continuous positive airway pressure (CPAP). The aim of this study was to assess the tolerability of restarting CPAP on postoperative day one. Study Design Prospective cohort study. Methods A prospective study on patients with OSA on CPAP who required a septoplasty/turbinectomy and/or functional endoscopic sinus surgery (FESS) was performed. Data from the memory card of a patient's CPAP machine and subjective information were obtained on the day of surgery and at scheduled follow‐up visits. All subjects were instructed to restart CPAP on the first postoperative night. Results A total of 14 patients were analyzed; nine underwent FESS and five had a septoplasty/turbinectomy. There were no postoperative complications encountered. The only significant change in the first postoperative week was a reduction in the percentage of nights used over 4 hours (P < .05). By the third postoperative visit, average 22‐item Sino‐Nasal Outcome Test, Nasal Obstruction Symptom Evaluation, and CPAP tolerance scores improved from preoperative values. CPAP pressures, residual apnea–hypopnea index, and number of hours and mean percentage of nights used remained stable throughout the study period. Conclusions Both quality‐of‐life and CPAP outcomes improved or remained the same when restarting CPAP immediately postoperatively. Combined with a lack of significant complications, this study suggests that CPAP is well‐tolerated when restarted the day after a septoplasty/turbinectomy or FESS. Level of Evidence 4 Laryngoscope, 131:E1013–E1018, 2021

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Survey of endoscopic skull base surgery practice patterns among otolaryngologists

Cited by 15 publications

References 48 publications

Qualitative Assessment of the Effect of Continuous Positive Airway Pressure on the Nasal Cavity

Qualitative Assessment of the Effect of Continuous Positive Airway Pressure on the Nasal Cavity

Incidence and Predictive Factors for Additional Opioid Prescription after Endoscopic Skull Base Surgery

Tolerance of Continuous Positive Airway Pressure After Sinonasal Surgery

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