- Email: [email protected]
Outpatient parathyroid surgery in the morbidly obese patient
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
9:30 AM to 10:20 AM Room JJCC 1A06 •
Practice Management Committee: Benchmarking Apples to Apples in the Big Apple
Steven F Isenberg, MD (moderator); Michael G Stewart, MD MPH Indianapolis IN; Houston TX Each year the AAO-HNS Practice Management Department performs a Socioeconomic Survey of the membership. This survey provides a great deal of valuable information that can be used to benchmark your performance. In this committee presentation, the Practice Management Committee will present the data. An interactive format will be used to survey the audience and probe further into the data. The audience will be stratified by net income and numerous benchmarks will be examined: ancillary services as related to income; number of full-time equivalents, hours worked, and number of patients seen as related to income; style of practice (solo, single-specialty group, multi-
10:30 AM to 12:00 PM Room JJCC 1A12 •
Scientific Session: Head and Neck Surgery Moderators: Mark K. Wax, Jr., MD
MD,
Eduardo M. Diaz
10:30 AM Outpatient Parathyroid Surgery in the Morbidly Obese Patient James Norman, MD (presenter); Loren J Bartels, MD Tampa FL; Tampa FL
Objectives: True outpatient parathyroidectomy has been shown to be safe for most patients. This prospective study examined the morbidly obese patient to determine if this highrisk group could undergo safe outpatient parathyroidectomy. Methods: From March through December 2003, 37 consecutive morbidly obese patients underwent outpatient parathyroid surgery for primary hyperparathyroidism. Morbid obesity was defined as 100 pounds above ideal body weight and/or BMI greater than 39. All underwent sestamibi scanning immediately prior to the operation and a gamma probe was used intraoperatively. All were discharged directly from the recovery room and followed with postoperative telephone interviews. Results: Thirty-seven (7.9% of all patients) were morbidly obese (range, 205–390 lbs; mean, 254 lbs). Thirty-five had a single adenoma; 2 had 4-gland hyperplasia. All operations were performed using laryngeal-masked airway anesthesia
specialty group) as related to practice income and areas of subspecialty as related to income. Members of the Practice Management Committee will present suggestions for efficient practices from their personal experiences, and attendees will be encouraged to participate actively in the discussions. An Internet-based ENT benchmarking network will be discussed. We will explore the quality-of-life issues in the current socioeconomic environment and issues related to retirement. Come and learn how your practice compares with other ENTs around the country. Dr Mickey Stewart will also review the basics of outcomes research and evidence-based medicine. Examples will be provided how such information can be used to benchmark the clinical practice of otolaryngology. Both the clinical and practice management aspects of otolaryngology will be integrated into a concept of “Evidence-based practice management.” The audience will participate actively in the interactive format, and with questions that will be addressed by a panel of members from the Practice Management Committee and the Outcomes Reasearch Subcommittee. Come and learn how your practice compares with other ENTs around the country.
with IV sedation. Four (9.2%) required conversion to general endotracheal anesthesia because of difficulty maintaining clear airway (P ⬍ 0.05 vs nonobese). Average operative time was 49 minutes (range, 21– 85), more than double that of nonobese patients (21.8 min; P ⬍ 0.0001). The average postoperative stay was 2.2 hours (range, 1 to 3.1 hours), which was longer than nonobese (mean, 1.3 hrs, P ⬍ 0.001). Postoperative telephone interviews identified no problems. None required medical intervention prior to their routine postop visit. All were cured of their disease. Conclusions: Morbid obesity is associated with a longer duration of operation, a more difficult airway, and a longer stay in the recovery room. Despite these differences, outpatient parathyroid surgery can be safely performed in this group just as it can in nonobese patients. 10:38 AM Primary and Secondary Tracheo-esophageal Puncture: Long-term Results with Voice Prosthesis Carlos Chone, MD PhD (presenter); Flavio M Gripp, MD; Erica Ortiz, MD; Antonio Bortoletto, MD; Ana L Spina, SLP; Agricio N Crespo, MD Campinas Brazil; Campinas Brazil; Campinas Brazil; Campinas Brazil; Campinas Brazil; Campinas Brazil
Objectives: To evaluate the long-term use of indwelling Blom-Singer voice prosthesis (VP) for vocal rehabilitation of patients submitted to total laryngectomy (TL). There were studied the influence of the time (primary or secondary) of accomplishment of tracheo-esophageal puncture (TEP), use
TUESDAY
Scientific Session—Tuesday P133
9:30 AM to 10:20 AM Room JJCC 1A06 •
Practice Management Committee: Benchmarking Apples to Apples in the Big Apple
Steven F Isenberg, MD (moderator); Michael G Stewart, MD MPH Indianapolis IN; Houston TX Each year the AAO-HNS Practice Management Department performs a Socioeconomic Survey of the membership. This survey provides a great deal of valuable information that can be used to benchmark your performance. In this committee presentation, the Practice Management Committee will present the data. An interactive format will be used to survey the audience and probe further into the data. The audience will be stratified by net income and numerous benchmarks will be examined: ancillary services as related to income; number of full-time equivalents, hours worked, and number of patients seen as related to income; style of practice (solo, single-specialty group, multi-
10:30 AM to 12:00 PM Room JJCC 1A12 •
Scientific Session: Head and Neck Surgery Moderators: Mark K. Wax, Jr., MD
MD,
Eduardo M. Diaz
10:30 AM Outpatient Parathyroid Surgery in the Morbidly Obese Patient James Norman, MD (presenter); Loren J Bartels, MD Tampa FL; Tampa FL
Objectives: True outpatient parathyroidectomy has been shown to be safe for most patients. This prospective study examined the morbidly obese patient to determine if this highrisk group could undergo safe outpatient parathyroidectomy. Methods: From March through December 2003, 37 consecutive morbidly obese patients underwent outpatient parathyroid surgery for primary hyperparathyroidism. Morbid obesity was defined as 100 pounds above ideal body weight and/or BMI greater than 39. All underwent sestamibi scanning immediately prior to the operation and a gamma probe was used intraoperatively. All were discharged directly from the recovery room and followed with postoperative telephone interviews. Results: Thirty-seven (7.9% of all patients) were morbidly obese (range, 205–390 lbs; mean, 254 lbs). Thirty-five had a single adenoma; 2 had 4-gland hyperplasia. All operations were performed using laryngeal-masked airway anesthesia
specialty group) as related to practice income and areas of subspecialty as related to income. Members of the Practice Management Committee will present suggestions for efficient practices from their personal experiences, and attendees will be encouraged to participate actively in the discussions. An Internet-based ENT benchmarking network will be discussed. We will explore the quality-of-life issues in the current socioeconomic environment and issues related to retirement. Come and learn how your practice compares with other ENTs around the country. Dr Mickey Stewart will also review the basics of outcomes research and evidence-based medicine. Examples will be provided how such information can be used to benchmark the clinical practice of otolaryngology. Both the clinical and practice management aspects of otolaryngology will be integrated into a concept of “Evidence-based practice management.” The audience will participate actively in the interactive format, and with questions that will be addressed by a panel of members from the Practice Management Committee and the Outcomes Reasearch Subcommittee. Come and learn how your practice compares with other ENTs around the country.
with IV sedation. Four (9.2%) required conversion to general endotracheal anesthesia because of difficulty maintaining clear airway (P ⬍ 0.05 vs nonobese). Average operative time was 49 minutes (range, 21– 85), more than double that of nonobese patients (21.8 min; P ⬍ 0.0001). The average postoperative stay was 2.2 hours (range, 1 to 3.1 hours), which was longer than nonobese (mean, 1.3 hrs, P ⬍ 0.001). Postoperative telephone interviews identified no problems. None required medical intervention prior to their routine postop visit. All were cured of their disease. Conclusions: Morbid obesity is associated with a longer duration of operation, a more difficult airway, and a longer stay in the recovery room. Despite these differences, outpatient parathyroid surgery can be safely performed in this group just as it can in nonobese patients. 10:38 AM Primary and Secondary Tracheo-esophageal Puncture: Long-term Results with Voice Prosthesis Carlos Chone, MD PhD (presenter); Flavio M Gripp, MD; Erica Ortiz, MD; Antonio Bortoletto, MD; Ana L Spina, SLP; Agricio N Crespo, MD Campinas Brazil; Campinas Brazil; Campinas Brazil; Campinas Brazil; Campinas Brazil; Campinas Brazil
Objectives: To evaluate the long-term use of indwelling Blom-Singer voice prosthesis (VP) for vocal rehabilitation of patients submitted to total laryngectomy (TL). There were studied the influence of the time (primary or secondary) of accomplishment of tracheo-esophageal puncture (TEP), use
TUESDAY
Scientific Session—Tuesday P133