476 results on '"Shrime, Mark G."'
Search Results
452. Global economic consequences of selected surgical diseases: a modelling study.
- Author
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Alkire BC, Shrime MG, Dare AJ, Vincent JR, and Meara JG
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- Digestive System Diseases economics, Digestive System Diseases mortality, Digestive System Diseases surgery, Gross Domestic Product, Humans, Maternal Health Services economics, Neoplasms economics, Neoplasms metabolism, Neoplasms surgery, Wounds and Injuries economics, Wounds and Injuries mortality, Wounds and Injuries surgery, Cost of Illness, Global Health, Health Expenditures, Surgical Procedures, Operative economics
- Abstract
Background: The surgical burden of disease is substantial, but little is known about the associated economic consequences. We estimate the global macroeconomic impact of the surgical burden of disease due to injury, neoplasm, digestive diseases, and maternal and neonatal disorders from two distinct economic perspectives., Methods: We obtained mortality rate estimates for each disease for the years 2000 and 2010 from the Institute of Health Metrics and Evaluation Global Burden of Disease 2010 study, and estimates of the proportion of the burden of the selected diseases that is surgical from a paper by Shrime and colleagues. We first used the value of lost output (VLO) approach, based on the WHO's Projecting the Economic Cost of Ill-Health (EPIC) model, to project annual market economy losses due to these surgical diseases during 2015-30. EPIC attempts to model how disease affects a country's projected labour force and capital stock, which in turn are related to losses in economic output, or gross domestic product (GDP). We then used the value of lost welfare (VLW) approach, which is conceptually based on the value of a statistical life and is inclusive of non-market losses, to estimate the present value of long-run welfare losses resulting from mortality and short-run welfare losses resulting from morbidity incurred during 2010. Sensitivity analyses were performed for both approaches., Findings: During 2015-30, the VLO approach projected that surgical conditions would result in losses of 1·25% of potential GDP, or $20·7 trillion (2010 US$, purchasing power parity) in the 128 countries with data available. When expressed as a proportion of potential GDP, annual GDP losses were greatest in low-income and middle-income countries, with up to a 2·5% loss in output by 2030. When total welfare losses are assessed (VLW), the present value of economic losses is estimated to be equivalent to 17% of 2010 GDP, or $14·5 trillion in the 175 countries assessed with this approach. Neoplasm and injury account for greater than 95% of total economic losses with each approach, but maternal, digestive, and neonatal disorders, which represent only 4% of losses in high-income countries with the VLW approach, contribute to 26% of losses in low-income countries., Interpretation: The macroeconomic impact of surgical disease is substantial and inequitably distributed. When paired with the growing number of favourable cost-effectiveness analyses of surgical interventions in low-income and middle-income countries, our results suggest that building surgical capacity should be a global health priority., Funding: US National Institutes of Health/National Cancer Institute., (Copyright © 2015 Alkire et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.)
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- 2015
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453. Impact of resident surgeons on procedure length based on common pediatric otolaryngology cases.
- Author
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Puram SV, Kozin ED, Sethi R, Alkire B, Lee DJ, Gray ST, Shrime MG, and Cohen M
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- Academic Medical Centers economics, Child, Child, Preschool, Clinical Competence, Cohort Studies, Cost-Benefit Analysis, Education, Medical, Graduate economics, Female, Humans, Length of Stay, Linear Models, Male, Medical Staff, Hospital, Multivariate Analysis, Operating Rooms economics, Otolaryngology education, Pediatrics, Retrospective Studies, Time Factors, Internship and Residency, Operating Rooms statistics & numerical data, Operative Time, Otorhinolaryngologic Surgical Procedures education, Otorhinolaryngologic Surgical Procedures methods
- Abstract
Objectives/hypothesis: Surgical education remains an important mission of academic medical centers. Financial pressures may favor improved operating room (OR) efficiency at the expense of teaching in the OR. We aim to evaluate factors, such as resident participation, associated with duration of total OR, as well as procedural time of common pediatric otolaryngologic cases., Study Design: Retrospective cohort study., Methods: We reviewed resident and attending surgeon total OR and procedural times for isolated tonsillectomy, adenoidectomy, tonsillectomy with adenoidectomy (T&A), and bilateral myringotomy with tube insertion between 2009 and 2013. We included cases supervised or performed by one of four teaching surgeons in children with American Society of Anesthesiology classification < 3. Regression analyses were used to identify predictors of procedural time., Results: We identified 3,922 procedures. Residents had significantly longer procedure times for all procedures compared to an attending surgeon (4.9-12.8 minutes, P < 0.001). Differences were proportional to case complexity. In T&A patients, older patient age and attending surgeon identity were also significant predictors of increased mean procedural time (P < 0.05)., Conclusions: Resident participation contributes to increased procedure time for common otolaryngology procedures. We found that differences in operative time between resident surgeons and attending surgeons are proportional to the complexity of the case, with additional factors, such as attending surgeon identity and older patient age, also influencing procedure times. Despite the increased procedural time, our investigation shows that resident education does not result in excessive operative times beyond what may be reasonably expected at a teaching institution., (© 2014 The American Laryngological, Rhinological and Otological Society, Inc.)
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- 2015
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454. Otolaryngology-specific emergency room as a model for resident training.
- Author
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Sethi RK, Kozin ED, Remenschneider AK, Lee DJ, Gliklich RE, Shrime MG, and Gray ST
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- Accreditation, Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Clinical Competence, Curriculum, Female, Humans, Male, Massachusetts, Middle Aged, Otorhinolaryngologic Surgical Procedures education, Retrospective Studies, Young Adult, Emergency Service, Hospital, Internship and Residency, Models, Educational, Otolaryngology education
- Abstract
Objectives/hypothesis: There is a paucity of data on junior resident training in common otolaryngology procedures such as ear debridement, nasal and laryngeal endoscopy, epistaxis management, and peritonsillar abscess drainage. These common procedures represent a critical aspect of training and are necessary skills in general otolaryngology practice. We sought to determine how a dedicated otolaryngology emergency room (ER) staffed by junior residents and a supervising attending provides exposure to common otolaryngologic procedures., Study Design: Retrospective review., Methods: Diagnostic and procedural data for all patients examined in the Massachusetts Eye and Ear Infirmary ER between January 2011 and September 2013 were evaluated., Results: A total of 12,234 patients were evaluated. A total of 5,673 patients (46.4%) underwent a procedure. Each second-year resident performed over 450 procedures, with the majority seen Monday through Friday (75%). The most common procedures in our study included diagnostic nasolaryngoscopy (52.0%), ear debridement (34.4%), and epistaxis control (7.0%), Conclusions: An otolaryngology-specific ER provides junior residents with significant diagnostic and procedural volume in a concentrated period of time. This study demonstrates utility of a unique surgical education model and provides insight into new avenues of investigation for otolaryngology training., (© 2014 The American Laryngological, Rhinological and Otological Society, Inc.)
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- 2015
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455. Charitable platforms in global surgery: a systematic review of their effectiveness, cost-effectiveness, sustainability, and role training.
- Author
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Shrime MG, Sleemi A, and Ravilla TD
- Subjects
- Cost-Benefit Analysis, Delivery of Health Care economics, Delivery of Health Care organization & administration, General Surgery economics, Humans, Medical Missions economics, Medical Missions organization & administration, Treatment Outcome, General Surgery organization & administration, Global Health, International Cooperation
- Abstract
Objective: This study was designed to propose a classification scheme for platforms of surgical delivery in low- and middle-income countries (LMICs) and to review the literature documenting their effectiveness, cost-effectiveness, sustainability, and role in training. Approximately 28 % of the global burden of disease is surgical. In LMICs, much of this burden is borne by a rapidly growing international charitable sector, in fragmented platforms ranging from short-term trips to specialized hospitals. Systematic reviews of these platforms, across regions and across disease conditions, have not been performed., Methods: A systematic review of MEDLINE and EMBASE databases was performed from 1960 to 2013. Inclusion and exclusion criteria were defined a priori. Bibliographies of retrieved studies were searched by hand. Of the 8,854 publications retrieved, 104 were included., Results: Surgery by international charitable organizations is delivered under two, specialized hospitals and temporary platforms. Among the latter, short-term surgical missions were the most common and appeared beneficial when no other option was available. Compared to other platforms, however, worse results and a lack of cost-effectiveness curtailed their role. Self-contained temporary platforms that did not rely on local infrastructure showed promise, based on very few studies. Specialized hospitals provided effective treatment and appeared sustainable; cost-effectiveness evidence was limited., Conclusions: Because the charitable sector delivers surgery in vastly divergent ways, systematic review of these platforms has been difficult. This paper provides a framework from which to study these platforms for surgery in LMICs. Given the available evidence, self-contained temporary platforms and specialized surgical centers appear to provide more effective and cost-effective care than short-term surgical mission trips, except when no other delivery platform exists.
- Published
- 2015
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456. Cost-effectiveness of transoral robotic surgery in the unknown primary: the problem of extended dominance.
- Author
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Shrime MG
- Subjects
- Cost-Benefit Analysis, Head and Neck Neoplasms secondary, Humans, Neoplasms, Unknown Primary pathology, Oral Surgical Procedures methods, Robotic Surgical Procedures methods, Treatment Outcome, Head and Neck Neoplasms surgery, Neoplasms, Unknown Primary surgery, Oral Surgical Procedures economics, Robotic Surgical Procedures economics
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- 2014
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457. Epidemiological survey of head and neck injuries and trauma in the United States.
- Author
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Sethi RK, Kozin ED, Fagenholz PJ, Lee DJ, Shrime MG, and Gray ST
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- Adolescent, Adult, Aged, Child, Child, Preschool, Female, Health Surveys, Humans, Infant, Male, Middle Aged, Prevalence, Retrospective Studies, United States epidemiology, Young Adult, Craniocerebral Trauma epidemiology, Neck Injuries epidemiology
- Abstract
Objective: Head and neck trauma results in a range of injuries, spanning minor lacerations to life-threatening airway compromise. Few studies provide in-depth analysis of injuries to the head and neck (HN). We aim to (1) describe HN injury prevalence in the US and (2) investigate patient disposition and the outcome of mortality., Study Design: Case series with chart review., Setting: Nationwide emergency department (ED) sample., Methods: The 2011 database was queried for encounters with a primary diagnosis of HN injury, as categorized by the Barell Injury Matrix. Weighted estimates for demographics, injury category, and mechanism were extracted. Predictors of mortality and admission were determined by multivariable regression., Results: We identified 131 million ED encounters. A weighted total of 5,418,539 visits were related to primary HN injuries. Average age was 30 (SE = 0.4), and 56.8% were male. Sixty-four percent of injuries were attributed to fall or blunt trauma. Open wounds comprised 41.8% of injuries. The most common procedure was laceration repair (70%). The majority of patients (97%) were discharged home. Mortality rate was less than 1%. Predictors of admission and mortality (P < .05) included multiple trauma, vessel trauma, and burns. Other risk factors included foreign-body, older age, and male gender., Conclusions: Primary HN injuries commonly present to emergency rooms in the US. The majority of HN injuries are non-life threatening and do not require admission to the hospital or result in death. These data have implications for HN injury surveillance and may be used to risk-stratify patients who present with injuries in the acute care setting., (© American Academy of Otolaryngology-Head and Neck Surgery Foundation 2014.)
- Published
- 2014
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458. Subspecialty emergency room as alternative model for otolaryngologic care: implications for emergency health care delivery.
- Author
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Sethi RK, Kozin ED, Remenschneider AK, Lee DJ, Gray ST, Shrime MG, and Gliklich RE
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Humans, Male, Massachusetts, Middle Aged, Models, Organizational, Otorhinolaryngologic Diseases surgery, Young Adult, Emergency Medical Services organization & administration, Emergency Service, Hospital organization & administration, Otorhinolaryngologic Diseases therapy
- Abstract
Purpose: A dedicated otolaryngology emergency room (ER) represents a specialized surgical evaluation and treatment setting that may be an alternative triage pathway for acute otolaryngologic complaints. We aim to characterize practice patterns in this setting and to provide insight into the epidemiology of all-comer, urgent otolaryngologic complaints in the United States., Methods and Methods: Electronic medical records were reviewed for all patients who registered for otolaryngologic care and received a diagnosis in the Massachusetts Eye and Ear Infirmary ER between January 2011 and September 2013. Descriptive analysis was performed to characterize utilization and diagnostic patterns. Predictors of inpatient admission were identified using multivariable regression. Geocoding analysis was performed to characterize catchment area., Results: A total of 12,234 patient visits were evaluated with a mean age of 44.7. Auditory and vestibular problems constituted the most frequent diagnoses (50.0%). The majority of patients were discharged home (92.3%). Forty-three percent of patients underwent a procedure in the ER; the most common procedure was diagnostic nasolaryngoscopy (52%). Predictors of inpatient admission were post-operative complaint (odds ratio [OR] 7.3, P<0.0001), arrival overnight (OR 3.3, P<0.0001), and laryngeal complaint (OR 2.4, P<0.0001). Patients traveled farther for evaluation of hearing loss (11 miles) and less for common diagnoses including impacted cerumen (7.1 miles) (P<0.0001)., Conclusion: In this report, we investigate practice patterns of a dedicated otolaryngology emergency room to explore an alternative to standard acute otolaryngologic health care delivery mechanisms. We identify key predictors of inpatient admission. This study has implications for emergency health care delivery models., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
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459. Cost-effectiveness of competing strategies for management of recurrent Clostridium difficile infection: a decision analysis.
- Author
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Konijeti GG, Sauk J, Shrime MG, Gupta M, and Ananthakrishnan AN
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- Aged, Aged, 80 and over, Clostridium Infections microbiology, Cost-Benefit Analysis, Decision Support Techniques, Female, Humans, Male, Middle Aged, Recurrence, Anti-Bacterial Agents economics, Anti-Bacterial Agents therapeutic use, Biological Therapy economics, Biological Therapy methods, Clostridioides difficile isolation & purification, Clostridium Infections prevention & control, Clostridium Infections therapy
- Abstract
Background: Clostridium difficile infection (CDI) is an important cause of morbidity and healthcare costs, and is characterized by high rates of disease recurrence. The cost-effectiveness of newer treatments for recurrent CDI has not been examined, yet would be important to inform clinical practice. The aim of this study was to analyze the cost effectiveness of competing strategies for recurrent CDI., Methods: We constructed a decision-analytic model comparing 4 treatment strategies for first-line treatment of recurrent CDI in a population with a median age of 65 years: metronidazole, vancomycin, fidaxomicin, and fecal microbiota transplant (FMT). We modeled up to 2 additional recurrences following the initial recurrence. We assumed FMT delivery via colonoscopy as our base case, but conducted sensitivity analyses based on different modes of delivery. Willingness-to-pay threshold was set at $50 000 per quality-adjusted life-year., Results: At our base case estimates, initial treatment of recurrent CDI using FMT colonoscopy was the most cost-effective strategy, with an incremental cost-effectiveness ratio of $17 016 relative to oral vancomycin. Fidaxomicin and metronidazole were both dominated by FMT colonoscopy. On sensitivity analysis, FMT colonoscopy remained the most cost-effective strategy at cure rates >88.4% and CDI recurrence rates <14.9%. Fidaxomicin required a cost <$1359 to meet our cost-effectiveness threshold. In clinical settings where FMT is not available or applicable, the preferred strategy appears to be initial treatment with oral vancomycin., Conclusions: In this decision analysis examining treatment strategies for recurrent CDI, we demonstrate that FMT colonoscopy is the most cost-effective initial strategy for management of recurrent CDI.
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- 2014
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460. Cost-effectiveness analysis of chromoendoscopy for colorectal cancer surveillance in patients with ulcerative colitis.
- Author
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Konijeti GG, Shrime MG, Ananthakrishnan AN, and Chan AT
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- Aged, Benchmarking, Female, Hospitals, University, Humans, Indiana, Male, Middle Aged, Retrospective Studies, Adenoma diagnosis, Colonoscopy standards, Colorectal Neoplasms diagnosis, Early Detection of Cancer standards, Population Surveillance, Quality Indicators, Health Care
- Abstract
Background: Recent studies report that the risk of colorectal cancer (CRC) among patients with ulcerative colitis (UC) may be lower than previously estimated. Although white-light endoscopy (WLE) with random biopsies is recommended for dysplasia detection in patients with UC, several studies reported increased detection of dysplasia by chromoendoscopy., Objective: To analyze the cost effectiveness of chromoendoscopy relative to WLE or no endoscopy for CRC surveillance in patients with UC., Design: Decision-analytic state-transition (Markov) model with Monte Carlo simulation., Setting: To simulate the clinical course of chronic UC, we estimated dysplasia and CRC incidence and progression, endoscopic test characteristics, stage-specific mortality rates, and costs from published literature and Medicare reimbursement data., Patients: Patients from a population-based age distribution with ulcerative colitis for ≥8 years., Intervention: We compared 3 different strategies at various surveillance intervals: chromoendoscopy with targeted biopsies, WLE with random biopsies, and no surveillance. The robustness of the model was assessed by using probabilistic sensitivity analysis. One-way sensitivity analyses were performed to evaluate individual variables, and 3-dimensional analysis was used to examine the effects of varying screening intervals., Main Outcome Measurements: Incremental cost-effectiveness ratio (ICER)., Results: Chromoendoscopy was found to be more effective and less costly than WLE at all surveillance intervals. However, compared with no surveillance, chromoendoscopy was cost effective only at surveillance intervals of at least 7 years, with an ICER of $77,176. Chromoendoscopy was the most cost effective strategy at sensitivity levels >0.23 for dysplasia detection and cost <$2200, regardless of the level of sensitivity of WLE for dysplasia detection. The estimated population lifetime risk of developing CRC ranged from 2.5% (annual chromoendoscopy) to 5.9% (chromoendoscopy every 10 years)., Limitations: Estimates used for the model are based on best available data in the literature., Conclusion: Chromoendoscopy is both more effective and less costly than WLE and becomes cost effective relative to no surveillance when performed at intervals of ≥7 years., (Copyright © 2014. Published by Mosby, Inc.)
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- 2014
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461. Outcomes of squamous cell cancer of the oral tongue managed at the Princess Margaret Hospital.
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Goldstein DP, Bachar GY, Lea J, Shrime MG, Patel RS, Gullane PJ, Brown DH, Gilbert RW, Kim J, Waldron J, Perez-Ordonez B, Davis AM, Cheng L, Xu W, and Irish JC
- Subjects
- Adult, Aged, Aged, 80 and over, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell pathology, Carcinoma, Squamous Cell radiotherapy, Female, Head and Neck Neoplasms mortality, Head and Neck Neoplasms pathology, Head and Neck Neoplasms radiotherapy, Humans, Lymph Node Excision, Male, Middle Aged, Neoplasm Invasiveness, Prognosis, Radiotherapy, Adjuvant, Retrospective Studies, Squamous Cell Carcinoma of Head and Neck, Tongue Neoplasms, Treatment Outcome, Young Adult, Carcinoma, Squamous Cell surgery, Head and Neck Neoplasms surgery
- Abstract
Background: The purpose of this study was to analyze the outcomes and treatment in patients with squamous cell carcinoma (SCC) of the oral tongue, as well as validate previously reported predictors of survival., Methods: We retrospectively reviewed 259 patients treated with curative intent between 1994 and 2004. Kaplan-Meier estimates, log-rank test, and Cox regression models were used for statistical analysis., Results: Two hundred fifty-nine patients were managed with surgery; 67 patients (25%) received adjuvant radiotherapy. Mean follow-up was 60 months. The 5-year local and regional control rates were 78% and 69.4%, respectively. The 5-year overall, disease-specific, and recurrence-free survival rates were 69%, 70.9%, and 53%, respectively. The only significant predictor of both overall survival (OS) and disease-free survival (DFS) on multivariable analysis was pathologic N classification., Conclusion: Treatment of early tongue SCC effectively achieves local control and DFS. Nodal disease remains to be 1 of the most important prognostic factors in terms of recurrence and survival., (Copyright © 2012 Wiley Periodicals, Inc.)
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- 2013
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462. Cost-effectiveness in otolaryngology.
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Shrime MG
- Subjects
- Female, Humans, Male, Calcium administration & dosage, Hypocalcemia drug therapy, Thyroidectomy adverse effects, Vitamin D administration & dosage
- Published
- 2012
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463. Radiotherapy in parotid acinic cell carcinoma: does it have an impact on survival?
- Author
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Andreoli MT, Andreoli SM, Shrime MG, and Devaiah AK
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- Adolescent, Adult, Aged, Aged, 80 and over, Carcinoma, Acinar Cell epidemiology, Carcinoma, Acinar Cell surgery, Child, Child, Preschool, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Parotid Neoplasms epidemiology, Parotid Neoplasms surgery, Retrospective Studies, SEER Program, Treatment Outcome, United States epidemiology, Carcinoma, Acinar Cell radiotherapy, Parotid Neoplasms radiotherapy
- Abstract
Objective: Acinic (or acinar) cell carcinoma (ACC) represents approximately 10% of salivary gland malignant tumors and most commonly occurs in the parotid gland. It carries a propensity for locoregional and distant metastasis. Although it is selectively used as an adjuvant in this tumor, radiotherapy (RT) has not been sufficiently examined in large population studies for survival impact., Design: Retrospective database review., Setting: Tertiary care center., Patients: A total of 1241 cases of parotid ACC in the Surveillance, Epidemiology, and End Results (SEER) Program database from 1988 to 2007 were identified and analyzed., Interventions: Comparison groups were surgery and surgery plus RT. Kaplan-Meier survival curves were generated for oncologic stage and histologic grade., Main Outcome Measures: Overall survival., Results: A total of 969 patients had sufficient staging data for inclusion. When comparing surgery with surgery with adjuvant RT, there was no statistical difference in overall survival when stratifying for stage I (P = .57), stage II (P = .37), stage III (P = .25), and stage IV (P = .24) tumors. Similarly, adjuvant RT did not demonstrate a survival advantage when stratified by histologic grade of tumor. The highest-grade and highest-stage tumors were fewer in number, however., Conclusions: To our knowledge, this study represents the largest cohort of patients treated for ACC of the parotid. Adjuvant RT does not seem to provide a significant survival advantage for early-stage or lower-grade parotid ACC. Radiotherapy for highest-stage and highest-grade tumors requires further study.
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- 2012
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464. Novel outpatient approach to lower lip reanimation using a palmaris longus tendon sling.
- Author
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Alexander AJ, de Almeida JR, Shrime MG, Goldstein DP, and Gilbert RW
- Subjects
- Academic Medical Centers, Adult, Aged, Aged, 80 and over, Articulation Disorders diagnosis, Articulation Disorders surgery, Cross-Sectional Studies, Esthetics, Facial Asymmetry diagnosis, Facial Asymmetry surgery, Female, Humans, Male, Middle Aged, Patient Satisfaction, Retrospective Studies, Smiling physiology, Ambulatory Surgical Procedures methods, Lip innervation, Mandibular Nerve, Paralysis surgery, Tendon Transfer methods, Trigeminal Nerve Injuries surgery
- Abstract
Objective: To report a new approach to lower lip reanimation, which can be performed in the outpatient clinic setting., Study Design: Cross-sectional study., Setting: Tertiary and quaternary care academic hospital, Toronto., Subjects and Methods: An evaluation of nine patients with marginal mandibular nerve injury, who underwent harvest of the palmaris longus tendon and static suspension of the lower lip, was performed in the outpatient setting. Outcome measures included subjective self-evaluation of the functional and aesthetic results using the Lip Reanimation Outcomes Questionnaire and postoperative photographic grading of symmetry at rest and during three smile poses. Medical records were reviewed for demographics and complications., Results: Seventy-eight percent of patients reported overall improvements in smiling, oral competence, and speech articulation following tendon transfer. Photographic grading by the judging panel found satisfactory smile symmetry postprocedure., Conclusions: The palmaris longus tendon sling procedure provides an effective, additional option for reanimation of the paralyzed lower lip.
- Published
- 2011
465. Flavonoid-rich cocoa consumption affects multiple cardiovascular risk factors in a meta-analysis of short-term studies.
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Shrime MG, Bauer SR, McDonald AC, Chowdhury NH, Coltart CE, and Ding EL
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- Cross-Over Studies, Dose-Response Relationship, Drug, Humans, Risk Factors, Cacao, Cardiovascular System physiopathology, Flavonoids administration & dosage
- Abstract
A growing body of evidence suggests that the consumption of foods rich in polyphenolic compounds, particularly cocoa, may have cardioprotective effects. No review, however, has yet examined the effect of flavonoid-rich cocoa (FRC) on all major cardiovascular risk factors or has examined potential dose-response relationships for these effects. A systematic review and meta-analysis of randomized, controlled trials was performed to evaluate the effect of FRC on cardiovascular risk factors and to assess a dose-response relationship. Inclusion and exclusion criteria as well as dependent and independent variables were determined a priori. Data were collected for: blood pressure, pulse, total cholesterol, HDL cholesterol, LDL cholesterol, TG, BMI, C-reactive protein, flow-mediated vascular dilation (FMD), fasting glucose, fasting insulin, serum isoprostane, and insulin sensitivity/resistance indices. Twenty-four papers, with 1106 participants, met the criteria for final analysis. In response to FRC consumption, systolic blood pressure decreased by 1.63 mm Hg (P = 0.033), LDL cholesterol decreased by 0.077 mmol/L (P = 0.038), and HDL cholesterol increased by 0.046 mmol/L (P = 0.037), whereas total cholesterol, TG, and C-reactive protein remained the same. Moreover, insulin resistance decreased (HOMA-IR: -0.94 points; P < 0.001), whereas FMD increased (1.53%; P < 0.001). A nonlinear dose-response relationship was found between FRC and FMD (P = 0.004), with maximum effect observed at a flavonoid dose of 500 mg/d; a similar relationship may exist with HDL cholesterol levels (P = 0.06). FRC consumption significantly improves blood pressure, insulin resistance, lipid profiles, and FMD. These short-term benefits warrant larger long-term investigations into the cardioprotective role of FRC.
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- 2011
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466. Development and preliminary validation of the lip reanimation outcomes questionnaire.
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de Almeida JR, Alexander AJ, Shrime MG, Gilbert RW, and Goldstein DP
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- Aged, Cohort Studies, Cross-Sectional Studies, Facial Paralysis etiology, Facial Paralysis surgery, Female, Humans, Lip Diseases pathology, Male, Middle Aged, Motor Activity physiology, Observer Variation, Quality of Life, Recovery of Function physiology, Reproducibility of Results, Treatment Outcome, Disability Evaluation, Facial Paralysis physiopathology, Lip Diseases physiopathology, Lip Diseases surgery, Surveys and Questionnaires
- Abstract
Objective: Lip paralysis is associated with eating, speaking, and appearance impairments. The lip reanimation outcome questionnaire is designed to assess these functional impairments after lip reanimation., Study Design: Cross-sectional validation study., Setting: Tertiary care academic center., Subjects and Methods: Patients who underwent lip reanimation and control subjects. A disease-specific instrument was created by systematic literature review and expert opinion. The 15-item patient completed subscale was administered to 20 lip reanimation patients. Photographs of 19 patients and three control subjects were taken in four poses and rated by six raters (2 surgeons, 2 residents, and 2 novices) by the use of a external rater subscale, and reliability was determined by the use of intraclass correlation coefficients (ICC). Content and construct validity were assessed., Results: Internal consistency (ICC range 0.813-0.915 for each domain), test-retest reliability (ICC range 0.616-0.981 for each item) for the patient completed subscale, and interrater (ICC = 0.852) and interlevel reliability (ICC = 0.929) for the external rater subscale were substantial to excellent. The content validity index was 0.87. Construct validity was demonstrated by poorer scores in patients with transected nerves versus intact nerves for appearance (P = 0.04) and oral competence (P = 0.011). Photographs of control patients had lower asymmetry scores (P < 0.001), and the instrument detected greater asymmetry in patients with progressively more exaggerated smile (P < 0.001)., Conclusion: The lip reanimation outcome questionnaire has promising reliability and validity in this preliminary study, but additional psychometric testing with larger samples is required before the survey can be recommended for clinical use., (Copyright 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.)
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- 2010
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467. The impact of adjuvant radiotherapy on survival in T1-2N1 squamous cell carcinoma of the oral cavity.
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Shrime MG, Gullane PJ, Dawson L, Kim J, Gilbert RW, Irish JC, Brown DH, and Goldstein DP
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- Carcinoma, Squamous Cell pathology, Carcinoma, Squamous Cell surgery, Humans, Mouth Neoplasms pathology, Mouth Neoplasms surgery, Neck Dissection, Radiotherapy, Adjuvant, SEER Program, Survival Rate, United States epidemiology, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell radiotherapy, Mouth Neoplasms mortality, Mouth Neoplasms radiotherapy
- Abstract
Objective: To evaluate the survival impact of postoperative radiation therapy (RT) in patients with early T stage (T1-2) oral cavity squamous cell carcinoma (OCSCC) and a single positive lymph node., Patients: Between 1983 and 2004, a total of 1539 patients were treated with surgery for T1-2N1 OCSCC., Main Outcome Measures: The Surveillance, Epidemiology, and End Results database was used to determine whether postoperative RT improves survival in patients with T1-2N1 OCSCC., Results: Postoperative RT improved the 5-year overall survival rate (41.4% for surgery alone vs 54.2% for surgery plus RT [P < .001]). Improvement in overall survival in patients with T1N1 disease did not achieve statistical significance with the addition of RT in contradistinction to that in patients with T2N1 disease. Adjuvant RT improved survival in patients with T2 tongue and floor of mouth disease (52.3% vs 37.9% [P = .002] and 39.9% vs 17.7% [P = .003], respectively)., Conclusion: In cases involving T1-2N1 OCSCC in the Surveillance, Epidemiology, and End Results database, the use of RT is associated with statistically significant improved overall survival and cause-specific survival in patients with T2 disease, most strongly in the oral tongue and the floor of the mouth.
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- 2010
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468. Nodal ratio as an independent predictor of survival in squamous cell carcinoma of the oral cavity.
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Shrime MG, Bachar G, Lea J, Volling C, Ma C, Gullane PJ, Gilbert RW, Irish JC, Brown DH, and Goldstein DP
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Carcinoma, Squamous Cell surgery, Cohort Studies, Disease-Free Survival, Female, Humans, Male, Middle Aged, Mouth Neoplasms surgery, Neck Dissection, Neoplasm Invasiveness, Neoplasm Staging, Predictive Value of Tests, Retrospective Studies, Survival Rate, Young Adult, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell secondary, Lymph Nodes pathology, Mouth Neoplasms mortality, Mouth Neoplasms pathology
- Abstract
Background: The association between nodal ratio and survival in oral cavity carcinomas has recently been proposed, but no prospective evaluations exist., Methods: We sought to determine, using an institutional database, whether nodal ratio impacts survival in node-positive oral cavity squamous cell carcinoma., Results: Between 1994 and 2004, 143 new diagnoses of N(1-2) squamous cell carcinoma of the oral cavity were identified. The mean number of nodes identified was 41.6, and the mean nodal ratio was 9%. Nodal ratio was strongly statistically associated with overall and disease-specific survival in both univariate and multivariate analyses. No other prognostic indicator maintained that degree of statistical significance. Patients could be stratified into low (0% to 6%), moderate (6% to 13%), and high-risk (>13%) groups based on nodal ratio., Conclusions: In squamous cell carcinoma of the oral cavity, an increased nodal ratio is a strong predictor of decreased survival. Risk of death can be stratified by nodal ratio., ((c) 2009 Wiley Periodicals, Inc. Head Neck, 2009.)
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- 2009
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469. Impact of nodal ratio on survival in squamous cell carcinoma of the oral cavity.
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Shrime MG, Ma C, Gullane PJ, Gilbert RW, Irish JC, Brown DH, and Goldstein DP
- Subjects
- Adult, Aged, Aged, 80 and over, Carcinoma, Squamous Cell therapy, Female, Humans, Lymphatic Metastasis, Male, Middle Aged, Mouth Neoplasms therapy, Neck Dissection, Prognosis, Proportional Hazards Models, Survival Analysis, Survival Rate, Young Adult, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell pathology, Mouth Neoplasms mortality, Mouth Neoplasms pathology
- Abstract
Background: The association between nodal ratio and survival has not been assessed in squamous cell carcinomas of the head and neck., Methods: This is a population-based analysis, using the Surveillance, Epidemiology, and End-Results database, to determine whether nodal ratio impacts survival in patients with oral cavity squamous cell carcinoma., Results: Between 1988 and 2005, 2955 new diagnoses of N(1) or N(2) squamous cell carcinoma of the oral cavity were identified. The mean nodal ratio was 16.9%. Nodal ratio was found to be strongly statistically associated with overall survival in both univariate and multivariate analyses. Patients could be stratified into low- (0% to 6%), moderate- (6% to 12.5%), and high-risk (>12.5%) groups based on nodal ratio., Conclusions: In patients with squamous cell carcinoma of the oral cavity, an increased nodal ratio is a strong predictor of decreased survival. Risk of death can be stratified based on nodal ratio.
- Published
- 2009
- Full Text
- View/download PDF
470. Reconstruction of the midface and maxilla.
- Author
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Shrime MG and Gilbert RW
- Subjects
- Esthetics, Humans, Surgical Flaps, Face surgery, Maxilla surgery, Plastic Surgery Procedures methods
- Abstract
The maxilla and midface have an important aesthetic and functional role. Their reconstruction after surgical ablation is a complex problem. The historical development of reconstruction of the midface, classification systems of maxillary defects, and descriptions of reconstructive options are presented.
- Published
- 2009
- Full Text
- View/download PDF
471. Cost-effective management of low-risk papillary thyroid carcinoma.
- Author
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Shrime MG, Goldstein DP, Seaberg RM, Sawka AM, Rotstein L, Freeman JL, and Gullane PJ
- Subjects
- Carcinoma, Papillary economics, Cost-Benefit Analysis, Decision Making, Humans, Risk Assessment, Thyroid Neoplasms economics, Thyroidectomy methods, United States, Carcinoma, Papillary surgery, Health Care Costs, Thyroid Neoplasms surgery, Thyroidectomy economics
- Abstract
Objective: To compare the 20-year cost-effectiveness of initial hemithyroidectomy vs total thyroidectomy in the management of small papillary thyroid cancer in the low-risk patient., Design: Pooled data from the published literature were used to determine key statistics for decision analysis such as rates of recurrence, rates of complications for all interventions undertaken, and rates of death. The 2005 costs were obtained from the US Department of Health and Human Services, as well as from Medicare reimbursement schedules. Future costs were discounted at 6%., Setting: Decision analysis study., Patients: Data from the published literature., Main Outcome Measures: A state-transition (Markov) decision model was constructed based on the most recent American Thyroid Association recommendations. A cost-effectiveness analysis was performed using fixed probability estimates and Monte Carlo microsimulation, with effectiveness defined as cause-specific mortality or recurrence-free survival. After identifying initial results, sensitivity and threshold analyses were performed to assess the strength of the recommendations., Results: Initial probability estimates were determined from a review of 940 abstracts and 31 relevant studies examining outcomes in patients with low-risk thyroid cancer undergoing thyroidectomy or neck dissection. During 20 years, cost estimates (including initial surgery, follow-up, and treatment of recurrence) were between $13,896.81 and $14,241.24 for total thyroidectomy and between $15,037.58 and $15,063.75 for hemithyroidectomy. Cause-specific mortality was similar for both treatment strategies, but recurrence-free survival was higher in the total thyroidectomy group. Sensitivity and threshold analyses demonstrated that these results were sensitive to rates of recurrence and cost of follow-up but remained robust when compared with willingness to pay., Conclusions: Total thyroidectomy dominates over hemithyroidectomy as initial treatment for low-risk papillary thyroid cancer. However, in sensitivity analyses, these results varied by institution because of heterogeneity in long-term treatment outcomes. With changing protocols of management, it is possible that hemithyroidectomy will emerge as being more cost-effective. Long-term prospective trials are necessary to validate our findings.
- Published
- 2007
- Full Text
- View/download PDF
472. Cost-effective diagnosis of ingested foreign bodies.
- Author
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Shrime MG, Johnson PE, and Stewart MG
- Subjects
- Decision Trees, Foreign Bodies diagnostic imaging, Humans, Sensitivity and Specificity, Cost-Benefit Analysis, Deglutition, Esophagoscopy economics, Foreign Bodies diagnosis, Laryngoscopy economics, Tomography, X-Ray Computed economics
- Abstract
Objectives: To compare the cost effectiveness of plain film radiography, computed tomography (CT), and endoscopy as initial diagnostic modalities in adult patients complaining of retained ingested foreign bodies., Design: A systematic literature review was conducted to determine key statistics for the analysis, such as prevalence of disease, prevalence of complications, and the sensitivity and specificity of each diagnostic modality. Costs were estimated using 2006 Medicare reimbursement for hospital and professional fees. A deterministic cost-effectiveness analysis was then conducted using decision analysis software and a decision tree model to evaluate the various diagnostic strategies. After identifying initial results, we also performed sensitivity and threshold analysis to assess the strength of the recommendations., Results: We reviewed 316 abstracts, identified 16 pertinent studies that included a total of 7,088 patients with possible foreign bodies, and extracted key statistics from those papers. Decision analysis showed that CT scanning as an initial diagnostic strategy proved more cost effective than plain film or operative endoscopy. The incremental cost of immediate endoscopy for every additional correctly diagnosed patient was $5,238. Plain radiography was more costly and less effective, even with the addition of confirmatory CT scanning after a negative plain film. Sensitivity and threshold analyses demonstrated that these results are robust., Conclusions: Patients presenting with a complaint of a retained ingested foreign body are most cost-effectively managed with CT scan, after history and physical. Immediate endoscopy may be considered if CT is not available, although it adds significant cost. Plain films are dominated by these two diagnostic strategies.
- Published
- 2007
- Full Text
- View/download PDF
473. Synechia formation after endoscopic sinus surgery and middle turbinate medialization with and without FloSeal.
- Author
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Shrime MG, Tabaee A, Hsu AK, Rickert S, and Close LG
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Endoscopy methods, Gelatin Sponge, Absorbable therapeutic use, Hemostatics therapeutic use, Otorhinolaryngologic Surgical Procedures methods, Postoperative Complications, Rhinitis surgery, Sinusitis surgery, Tissue Adhesions etiology, Turbinates surgery
- Abstract
Background: The aim of this study was to determine the incidence, outcomes, and risk factors for synechia formation after endoscopic sinus surgery (ESS) and middle turbinate medialization with and without FloSeal., Methods: A retrospective review was performed of patients who underwent primary ESS with middle turbinate medialization, with or without the placement of FloSeal. Medialization was performed with the placement of an absorbable conchopexy suture and silastic splint. Operative variables and outcomes were analyzed to identify risk factors for synechia formation., Results: One hundred thirty-five patients underwent medialization alone and 37 patients underwent medialization with placement of FloSeal. Overall, synechia formation was noted in 16 patients (9.3%). A statistically significant higher incidence of synechia formation was noted in patients who underwent middle turbinate medialization with the placement of FloSeal versus medialization alone (18.9% versus 6.7%). The incidences of intraoperative complications (6.2% versus 4.7%) and postoperative complications (6.2% versus 7%) were similar between patients with and without synechia, respectively. Patients experiencing synechia, however, underwent a statistically significant higher rate of revision procedures (25% versus 5.1%)., Conclusion: Despite adequate prevention with middle turbinate medialization, synechia formation after ESS may result in higher rates of revision procedures. The placement of FloSeal in conjunction with middle turbinate medialization may result in a higher incidence of synechia formation.
- Published
- 2007
- Full Text
- View/download PDF
474. Radiology quiz case 1: Intraosseous schwannoma of the mandible.
- Author
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Shrime MG, Wilson TB, Eisig SB, and Haddad J
- Subjects
- Child, Humans, Male, Mandibular Neoplasms pathology, Neurilemmoma pathology, Tomography, X-Ray Computed, Mandibular Neoplasms diagnostic imaging, Neurilemmoma diagnostic imaging
- Published
- 2007
- Full Text
- View/download PDF
475. The relationship between oral malodor and volatile sulfur compound-producing bacteria.
- Author
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Krespi YP, Shrime MG, and Kacker A
- Subjects
- Halitosis therapy, Humans, Halitosis microbiology, Sulfur Compounds metabolism, Tongue microbiology
- Abstract
Halitosis can be a crippling social problem, and standard dental treatments and mouthwashes often provide only temporary relief. The mouth is home to hundreds of bacterial species that produce several fetid substances as a result of protein degradation. Volatile sulfur compound (VSC)-producing bacteria colonizing the lingual dorsum have recently been implicated in the generation of halitosis. Detection of VSCs, such as methylmercaptan and hydrogen sulfite, via organoleptic and objective methods, can aid in the identification of their source. Following comprehensive evaluation for possible causes, most halitosis in patients seen in an ENT practice can be localized to the tongue. We review methods of diagnosis and treatment of oral malodor from the overgrowth of proteolytic, anaerobic, gram-negative bacteria on the crevices of the lingual dorsum. Bacteriologic analysis of biofilm and scraped specimens obtained from the lingual dorsum and other oral sites, primarily gingival pockets and tonsillar crypts, can identify VSC-producing bacteria. Porphyromonas, Prevotella, Actinobacillus, and Fusobacterium species are the most common organisms identified. Halitosis is an oral phenomenon, with almost no cases originating distal to the tonsils. Halitosis arising from the lingual dorsum secondary to overpopulated VSC-producing bacteria can be successfully managed with a combination of mechanical cleansing using tongue brushes or scrapes and chemical solutions containing essential oils, zinc chloride, and cetylpyridinium chloride.
- Published
- 2006
- Full Text
- View/download PDF
476. Quality of life and complications following image-guided endoscopic sinus surgery.
- Author
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Tabaee A, Hsu AK, Shrime MG, Rickert S, and Close LG
- Subjects
- Adolescent, Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Otorhinolaryngologic Surgical Procedures methods, Paranasal Sinus Diseases psychology, Retrospective Studies, Surveys and Questionnaires, Treatment Outcome, Endoscopy methods, Otorhinolaryngologic Surgical Procedures psychology, Paranasal Sinus Diseases surgery, Paranasal Sinuses surgery, Quality of Life, Surgery, Computer-Assisted methods
- Abstract
Objectives: To compare the quality of life (QOL) outcome and incidence of complications following image-guided versus non-image-guided endoscopic sinus surgery (ESS)., Study Design: The operative, office, and hospital charts of patients who underwent primary ESS for chronic sinusitis by a single surgeon with (2002-2005) or without (1997-2002) image guidance were reviewed for patient demographics, incidence of complications, and revision procedures. A telephone survey was used to administer the QOL survey to both cohorts., Results: In comparing patients who underwent image-guided (60) versus non-image-guided surgery (179), respectively, there was no statistically significant difference in the incidence of major intraoperative complications (6.6% vs 5.6%), major postoperative complications (5% vs 3.9%), revision procedures (6.6% vs 7.3%), and postoperative SNOT-20 symptom scores (23.6 vs 23.4). A higher incidence of intraoperative cerebrospinal fluid leak was noted in the non-image-guided group (0% vs 2.2%)., Conclusions: Our study does not demonstrate an improvement in the incidence of complications, need for revision procedures, or quality-of-life outcome for patients undergoing primary ESS for chronic sinusitis. The use of image guidance may result in a lower incidence of skull base trauma and cerebrospinal fluid leak., Ebm Rating: B-2b.
- Published
- 2006
- Full Text
- View/download PDF
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