Many organ procurement organizations (OPOs) utilize preset critical care endpoints as donor management goals (DMGs) in order to standardize care and improve outcomes. The objective of this study was to determine the impact of meeting DMGs on delayed graft function (DGF) in renal transplant recipients. All eight OPOs of the United Network for Organ Sharing Region 5 prospectively implemented nine DMGs in every donor after neurologic determination of death (DNDD). "DMGs met" was defined a priori as achieving any seven of the nine DMGs and this was recorded at the time of consent for donation to reflect donor hospital ICU management, 12-18 h later, and prior to organ recovery. Multivariable analyses were performed to identify independent predictors of DGF (dialysis in the first week after transplantation) with a p < 0.05. A total of 722 transplanted kidneys from 492 DNDDs were included. A total of 28% developed DGF. DMGs were met at consent in 14%, 12-18 h in 32% and prior to recovery in 38%. DGF was less common when DMGs were met at consent (17% vs. 30%, p = 0.007). Independent predictors of DGF were age, Cr and cold ischemia time, while meeting DMGs at consent was significantly protective. The management of potential organ donors prior to consent affects outcomes and should remain a priority in the intensive care unit.

The data reveal significant improvement in speech perception performance in quiet and in noise in patients with single-sided deafness after implantation. Performance might depend on factors including length of hearing loss, age at implantation, and device usage.

Objectives. We sought to investigate the postoperative complications of vestibular schwannoma excision and determine their significant clinical predictors.Study Design. Cross-sectional. Setting. California Hospital Inpatient Discharge Datasets 1997-2011.Subjects and Methods. Data for vestibular schwannoma excisions performed in California were extracted using the ICD-9-CM code ''04.01 excision of acoustic neuroma. '' Demographics, principal payer, state of residence, comorbidities, as well as hospital case volume were examined as possible predictors. Postoperative complications and patient disposition were examined as outcome variables. Comorbidities and complications were identified using ICD-9-CM diagnoses and procedures codes.Results. Overall, 6553 cases were examined. Comorbidities were present in 2539 (38.7%) patients. Postoperative complications occurred in 1846 (28.2%) patients; 1714 (26.2%) neurological and 337 (5.1%) medical complications. Patients' admission ended with death or further care (ie, skilled nursing facilities) in 260 (4.0%) cases. Mortality rate was 0.2%. No significant changes were observed over time. Multivariate analysis revealed that the odds of neurological complications were greater in the 2007-2011 period (OR = 1.51; 95% CI, 1.12-2.04), in patients with comorbidities (OR = 1.48; 95% CI, 1.16-1.88), and in hospitals with low case volume (OR = 1.69; 95% CI. 1.31-2.18). The odds of medical complications were also greater in the 2007-2011 period (OR = 1.69; 95%, CI 1.02-2.80). Female gender, non-Caucasian ethnicity, presence of comorbidities, and low hospital case volume were associated with greater odds of patients requiring further care.Conclusion. Comorbidities and low hospital case volume were major risk factors for complications. No significant changes in rates of complications from vestibular schwannoma surgery were observed over the 15-year period.

Objective. To assess demographics, charges, and outcome measures by temporal and volume analysis in the treatment of vestibular schwannoma.Design. Cross-sectional analysis.Setting, Subjects, and Methods. The California Hospital Inpatient Discharge Databases from 1996 to 2010.Results. A total of 6545 cases from 1996 to 2010 were identified. Of these, 86.2% occurred at high-volume centers (HVCs), and the number of annual cases decreased by 28.5% over the study period. Patients presenting for surgery were increasingly younger, non-Caucasian, and likely to have comorbidities. Total charges significantly increased over time (P \ .001), with the median total charge in 2006-2010 being $91,338 compared with $38,607.92 in 1996-2000 after adjusting for inflation. Routine discharges (home or residence) were more likely at HVCs (odds ratio [OR] 5.48, P \ .001) and less likely if patients had Medicaid (Medi-Cal; OR 0.51, P = .002) or Medicare (OR 0.55, P = .022), were 65 years or older (OR 0.56, P = .025), or had comorbidities (OR 0.54, P \ .001). Shorter hospital stays were more likely at HVCs (OR 3.77, P \ .001) and less likely if patients had Medicaid (OR 0.36, P \ .001) or comorbidities (OR 0.61, P \ .001). Lesser total charges were more likely at HVCs (OR 2.12, P = .002) and less likely if patients had comorbidities (OR 0.70, P \ .001). Mortality was less likely at HVCs (OR 0.10, P = .011).Conclusion. The profile of patients undergoing vestibular neuroma excision is changing. Surgical volume is decreasing, suggesting a trend toward more conservative management or stereotactic radiation. Patients are best served at HVCs, where routine discharges, shorter length of stay, decreased mortality, and lower total charges are more likely.

Objective Perioperative lumbar drain (LD) use in the setting of endoscopic cerebrospinal fluid (CSF) leak repair is a well-established practice. However, recent data suggest that LDs may not provide significant benefit and may thus confer unnecessary risk. To examine this, we conducted a meta-analysis to investigate the effect of LDs on postoperative CSF leak recurrence following endoscopic repair of CSF rhinorrhea. Data Sources A comprehensive search was performed with the following databases: Ovid MEDLINE (1947 to November 2015), EMBASE (1974 to November 2015), Cochrane Review, and PubMed (1990 to November 2015). Review Method A meta-analysis was performed according to PRISMA guidelines. Results A total of 1314 nonduplicate studies were identified in our search. Twelve articles comprising 508 cases met inclusion criteria. Overall, use of LDs was not associated with significantly lower postoperative CSF leak recurrence rates following endoscopic repair of CSF rhinorrhea (odds ratio: 0.89, 95% confidence interval: 0.40-1.95) as compared with cases performed without LDs. Subgroup analysis of only CSF leaks associated with anterior skull base resections (6 studies, 153 cases) also demonstrated that lumbar drainage did not significantly affect rates of successful repair (odds ratio: 2.67, 95% confidence interval: 0.64-11.10). Conclusions There is insufficient evidence to support that adjunctive lumbar drainage significantly reduces postoperative CSF leak recurrence in patients undergoing endoscopic CSF leak repair. Subgroup analysis examining only those patients whose CSF leaks were associated with anterior skull base resections demonstrated similar results. More level 1 and 2 studies are needed to further investigate the efficacy of LDs, particularly in the setting of patients at high risk for CSF leak recurrence.

NA Laryngoscope, 1783-1790, 2018.

Objectives/Hypothesis: To describe the distribution of recurrent respiratory papillomatosis (RRP) lesions across 21 laryngeal anatomic regions in previously untreated patients at initial presentation to provide insight regarding the natural history of RRP.Study Design: Multi-institutional, retrospective case series. Methods: Initial laryngoscopic examination videos of 83 previously untreated patients with adult-onset RRP were reviewed. Papilloma locations were recorded using a 21-region laryngeal schematic. Multivariate analyses by anatomic subsite were conducted for the entire population and for subgroups stratified by sex, age, and proton pump inhibitor (PPI) usage. Heat maps were generated, hierarchically color coding the anatomic distribution of disease.Results: In this cohort, RRP was most likely to occur on the true vocal folds (TVFs) and anterior commissure (P <.0001, odds ratio [OR]: 7.02); within the TVFs, the membranous vocal folds (MVFs) were most likely to be affected (P <.0001, OR: 3.56). The cohort was predominantly male (80.7%); males had a higher average number of affected sites (P 5.005) and were more likely to have lesions in any laryngeal subsite (P <.0001, OR: 2.88,) compared to females. PPI users were more likely than nonusers to have disease in any laryngeal subsite (P 5.0037, OR: 1.62), particularly in the posterior and subglottic regions (P 5.0061, OR: 2.53). Age was not correlated with lesion prevalence or distribution.Conclusions: In untreated patients presenting to three laryngology clinics, the MVFs were most likely to be affected by RRP. Males had more anatomic sites affected by papilloma than females. The influence of PPI use on RRP distribution warrants further investigation.

Objective/Hypothesis Frailty has emerged as a powerful risk stratification tool across surgical specialties; however, an analysis of the impact of frailty on outcomes following skull base surgery has not been published. The aim of this study was to assess the validity of the 5‐factor modified frailty index (mFI‐5) as a predictor of perioperative morbidity and mortality in patients undergoing skull base surgery. Methods A mFI‐5 score was calculated for patients undergoing skull base surgeries using the National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2018. Multivariate logistic regression analysis was used to evaluate the association of increasing frailty with complications in the 30‐day postoperative period, with a subanalysis by operative location. Results A total of 17,912 patients who underwent skull base procedures were identified, with 45.5% of patients having a frailty score of one or greater; 44.9% were male and the mean age was 52.0 (±16.1 SD) years. Multivariable regression analysis revealed frailty to be an independent predictor of overall complications (odds ratio [OR]: 1.325, P < .001), life‐threatening complications (OR: 1.428, P < .001), and mortality (OR: 1.453, P < .001). Higher frailty also correlated with increased length of stay. When procedures were stratified by operative location, frailty correlated significantly with overall complications for middle, posterior, and multiple‐fossae operations but not the anterior fossa. Conclusions Frailty demonstrates a significant and stepwise association with life‐threatening postoperative morbidity, mortality, and length of stay following skull base surgeries. mFI‐5 is an objective and easily calculable measure of preoperative risk, which may facilitate perioperative planning and counseling regarding outcomes prior to surgery. Level of Evidence 3 Laryngoscope, 131:1977–1984, 2021