To Pack or Not to Pack: Inpatient Management of Epistaxis in the Elderly

Abstract

Background Epistaxis is common in elderly patients, occasionally necessitating hospitalization for the management of severe bleeds. In this study, we aim to explore the impact of nasal packing versus nonpacking interventions (cauterization, embolization, and ligation) on outcomes and complications of epistaxis hospitalization in the elderly. Methods The 2008–2013 National Inpatient Sample was queried for elderly patients (≥65 years) with a primary diagnosis of epistaxis and accompanying procedure codes for anterior and posterior nasal packing or nonpacking interventions. Results A total of 8449 cases met the inclusion criteria, with 62.4% receiving only nasal packing and 37.6% receiving nonpacking interventions. On average, nonpacking interventions were associated with a 9.9% increase in length of stay and a 54.0% increase in hospital charges. Comorbidity rates did not vary between cohorts, except for diabetes mellitus, which was less common in the nonpacking cohort (26.6% vs 29.0%; P = .014). Nonpacking interventions were associated with an increased rate of blood transfusion (24.5% vs. 21.8%; P = .004), but no significant differences in rates of stroke, blindness, aspiration pneumonia, infectious pneumonia, thromboembolism, urinary/renal complications, pulmonary complications, cardiac complications, or in-hospital mortality. Comparing patients receiving ligation or embolization, no differences in length of stay, complications, or in-hospital mortality were found; however, embolization patients incurred 232.1% greater hospital charges ( P < .001). Conclusion Nonpacking interventions in the elderly do not appear to be associated with increased morbidity or mortality when compared to nasal packing only but appear to be associated with increased hospital charges and length of stay. Embolization in the elderly results in greater hospital charges but no change in outcome when compared to ligation.

Does Length Matter? A Comparison of Rapid Rhino™ Nasal Packings for the Treatment of Epistaxis

“…We did not calculate the treatment costs for each individual patient in this project, but formerly published studies showed admission to in-patient treatment and the duration of the in-patient stay to be the biggest cost factors for epistaxis patients. 14,28,29 In cases where epistaxis could be managed in an outpatient setting, treatment with Rapid Rhino TM nasal packs was shown to be very cost-effective and comparable to chemical or bipolar coagulation. 14,28 The exact times of the insertion and removal of nasal packings were hardly ever noted in patient files, thus we only had units of days, not hours, available for the calculation of duration of nasal packing.…”

Etiological factors of resistant epistaxis and their effects on treatment outcomes

“…Genç bireylerde etiyolojik etken olarak; travma, idiyopatik etkenler, enfeksiyon, alerjik rinit, kanama bozukluğu, AVM görülürken, yaşlı bireylerde daha sıklıkla HT ve AK kullanımı karşımıza çıkmaktadır. [15] Epistaksis kendiliğinden ya da konservatif yöntemlerle durabildiği gibi ileri cerrahi tedaviler ve hastaneye yatırılarak gözlem gerekebilir. Müdahaleler genellikle basamaklı olarak uygulanmakla birlikte bazen ileri tedaviler, konservatif tedavilerden önce de uygulanabilmektedir.…”

“…[13,30] Zhou ve ark. [15] yaşlı epistaksis hastalarında ECM ve AE uygulanan hastalarla, tampon uygulanan hastaları karşılaştırmış iki grup arasında morbidite ve mortalite açısından fark olmadığını, iki yönteminde güvenilir olduğunu ancak ECM ve AE'nin hastanede kalış süresini %9.9 oranında, hastane masraflarını ise %54 oranında artırdığını bildirmişlerdir.…”

Geographic Variation in Epistaxis Interventions Among Medicare Beneficiaries

“…[23][24][25] It is also possible that rates of the procedures investigated in our study decreased due to otolaryngologists instead opting to perform endoscopic SPA ligation, which has become a preferred option for epistaxis management in recent years due to its efficacy, safety, and cost-effectiveness compared with other interventions. [26][27][28][29] Since no CPT code existed for endoscopic SPA ligation between 2013 and 2016, information on the utilization of this procedure was not captured in our study. Finally, the decreasing procedure utilization rates may reflect decreased rates of epistaxis in the elderly population, possibly due to improved patient education regarding epistaxis prevention.…”