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  • National Trends in Opioid Prescriptions Following Outpatient Otologic Surgery, 2005-2017. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Cooperman, S. P., Jin, M. C., Qian, Z. J., Alyono, J. C. 2021: 194599821994755

    Abstract

    OBJECTIVE: To describe opioid stewardship in ambulatory otologic surgery from 2005 to 2017.STUDY DESIGN: Descriptive study of US private insurance claims.SETTING: Nationwide deidentified private insurance claims database (Clinformatics DataMart; Optum).METHODS: A total of 17,431 adult opioid-naive outpatients were included in the study. Patients were identified from CPT-4 codes (Current Procedural Terminology, Fourth Edition) as having undergone middle ear or mastoid surgery. Multiple regression was used to determine sociodemographic and geographic predictors of postoperative morphine milligram equivalents (MMEs) prescribed, including procedure type, year of procedure, age, sex, education, income level, and geographic region of the United States.RESULTS: The mean prescribed perioperative dose over the examined period was 203.03 MMEs (95% CI, 200.27-205.79; 5-mg hydrocodone pill equivalents, 40.61). In multivariate analysis, patients undergoing mastoid surgery were prescribed more opioids than those undergoing middle ear surgery (mean difference, 39.89 MME [95% CI, 34.37-45.41], P < .01; 5-mg hydrocodone pill equivalents, 8.0). Men were prescribed higher doses than women (mean difference, 15.39 [95% CI, 9.87-20.90], P < .01; 5-mg hydrocodone pill equivalents, 3.1). Overall MMEs prescribed by year demonstrates a sharp drop in MMEs from 2015 to 2017.CONCLUSION: While the amount of opioids prescribed perioperatively has declined in recent years, otologists should continue to be cognizant of potential overprescribing in light of previous studies of patients' relatively low opioid intake.

    View details for DOI 10.1177/0194599821994755

    View details for PubMedID 33618561

  • Assessment of Inter- and Intra-Rater Reliability of Tablet-Based Software to Measure Cochlear Duct Length. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Cooperman, S. P., Aaron, K. A., Fouad, A., Tran, E., Blevins, N. H., Fitzgerald, M. B. 2021

    Abstract

    OBJECTIVE: The objective of this study is to build upon previous work validating a tablet-based software to measure cochlear duct length (CDL). Here, we do so by greatly expanding the number of cochleae (n = 166) analyzed, and examined whether computed tomography (CT) slice thickness influences reliability of CDL measurements.STUDY DESIGN: Retrospective chart review study.SETTING: Tertiary referral center.PATIENTS: Eighty-three adult cochlear implant recipients were included in the study. Both cochleae were measured for each patient (n = 166).INTERVENTIONS: Three raters analyzed the scans of 166 cochleae at 2 different time points. Each rater individually identified anatomical landmarks that delineated the basal turn diameter and width. These coordinates were applied to the elliptic approximation method (ECA) to estimate CDL. The effect of CT scan slice thickness on the measurements was explored.MAIN OUTCOME MEASURES: The primary outcome measure is the strength of the inter- and intra-rater reliability.RESULTS: The mean CDL measured was 32.84 ± 2.03 mm, with a range of 29.03 to 38.07 mm. We observed no significant relationship between slice thickness and CDL measurement (F1,164 = 3.04; p = 0.08). The mean absolute difference in CDL estimations between raters was 1.76 ± 1.24 mm and within raters was 0.263 ± 0.200 mm. The intra-class correlation coefficient (ICC) between raters was 0.54 and ranged from 0.63 to 0.83 within raters.CONCLUSIONS: This software produces reliable measurements of CDL between and within raters, regardless of CT scan thickness.

    View details for DOI 10.1097/MAO.0000000000003015

    View details for PubMedID 33492059

  • Trends in Use and Timing of Intratympanic Corticosteroid Injections for Sudden Sensorineural Hearing Loss. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Jin, M. C., Qian, Z. J., Cooperman, S. P., Alyono, J. C. 2020: 194599820976177

    Abstract

    OBJECTIVE: Oral corticosteroids are treatment mainstays for idiopathic sudden sensorineural hearing loss (SSNHL). Recent studies suggest that intratympanic (IT) steroid injections may be effective as an alternate or adjunctive therapy. We sought to investigate nationwide trends in treatment patterns for SSNHL.STUDY DESIGN: Retrospective cross-sectional study.SETTING: A large nationwide health care claims database spanning 2007 to 2016.METHODS: Patients with SSNHL were identified from the IBM Watson Health MarketScan Database. Multivariable logistic, linear, and Cox regression were used for demographic- and comorbidity-adjusted analyses.RESULTS: Overall, 19,670 patients were included. Between 2007 and 2016, use of oral corticosteroids alone decreased (83.6% to 64.6%, P < .001), while use of IT corticosteroids alone and combination IT-oral corticosteroids increased (IT only, 7.9% to 15.1%, P = .002; IT-oral, 8.5% to 20.4%, P < .001). During the study period, time to treatment initiation decreased for both administration modalities, though more dramatically for IT corticosteroids (IT, 124.0 to 10.6 days, P < .001; oral, 42.6 to 12.7 days, P < .001). In patients receiving both IT and oral corticosteroids, concurrent first-line use increased (25.2% to 52.8%, P < .001). Repeat injections have also become more common but may raise risk of persistent tympanic membrane perforations (vs no injection; hazard ratio [first injection] = 7.95, 95% CI = 5.54-11.42; hazard ratio [fifth or higher injection] = 17.47, 95% CI = 6.93-44.05).CONCLUSION: SSNHL management increasingly involves early IT steroids as an alternative or adjunctive option to oral steroids. Use of repeat IT corticosteroid injections has also increased but may raise risk of persistent tympanic membrane perforations and subsequent tympanoplasty. Future decision analysis and cost-effectiveness studies are necessary to identify an optimal care pattern for SSNHL.

    View details for DOI 10.1177/0194599820976177

    View details for PubMedID 33287664

  • Opioid Prescribing Patterns Following Pediatric Tonsillectomy in the United States, 2009-2017. The Laryngoscope Qian, Z. J., Alyono, J. C., Jin, M. C., Cooperman, S. P., Cheng, A. G., Balakrishnan, K. 2020

    Abstract

    OBJECTIVES: Assess national trends in opioid prescription following pediatric tonsillectomy: 1) overall percentage receiving opioids and mean quantity, 2) changes during 2009-2017, and 3) determinants of prescription patterns.METHODS: Cross-sectional analysis using 2009-2017 Optum claims data to identify opioid-naive children aged 1-18 with claims codes for tonsillectomy (n = 82,842). Quantities of opioids filled in outpatient pharmacies during the perioperative period were extracted and converted into milligram morphine equivalents (MMEs) for statistical comparison. Demographic, clinical, and socioeconomic predictors of opioid fill rate and quantity were determined using regression analyses.RESULTS: In 2009, 83.3% of children received opioids, decreasing to 58.3% by 2017. Rates of all-cause readmissions and post-tonsillectomy hemorrhages were similar over time. Mean quantity received was 153.47MME (95% confidence intervals [95%CI]: 151.19, 155.76) and did not significantly change during 2009-2017. Opioids were more likely in older children and those with higher household income, but less likely in children with obstructive sleep apnea, other comorbidities, and Hispanic race. Higher quantities of opioids were more likely in older children, while lower quantities were associated with female sex, Hispanic race, and higher household income. Outpatient steroids were prescribed to 8.04% of patients, who were less likely to receive opioids.CONCLUSION: While the percentage of children receiving post-tonsillectomy opioids decreased during 2009-2017, prescribed quantities remain high and have not decreased over time. Prescription practices were also influenced by clinical and sociodemographic factors. These results highlight the need for guidance, particularly with regard to opioid quantity, in children after tonsillectomy.LEVEL OF EVIDENCE: N/A Laryngoscope, 2020.

    View details for DOI 10.1002/lary.29159

    View details for PubMedID 33026683