The Effects of Obstructive Sleep Apnea on Pulmonary Arterial Pressures: A Retrospective Chart Review at One Academic Medical Center.

Cushing disease is a relatively rare cause of Cushing syndrome secondary to a hyperfunctioning pituitary adenoma. In addition to signs and symptoms of hypercortisolism, Cushing disease may present with diverse otolaryngic manifestations, which may guide diagnosis and management. We performed a retrospective chart review of patients who were found to have Cushing disease and who underwent transnasal transsphenoidal surgery for pituitary adenomas between January 1, 2007, and July 1, 2014, at a tertiary academic medical center. There were 37 consecutive patients in this series with Cushing disease caused by a pituitary adenoma. Fifteen (41%) patients complained of visual changes. Five (14%) patients suffered from obstructive sleep apnea. Four (11%) patients had thyroid disease. Other symptoms included hearing loss, vertigo, tinnitus, epistaxis, dysphagia, and salivary gland swelling. Although Cushing disease traditionally presents with classic “Cushingoid” systemic features, it also may present with various otolaryngic manifestations. A thorough workup by otolaryngologists is critical in the comprehensive management of these patients.

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An Ophthalmology Resident-Led Quality Improvement Initiative to Decrease the Incidence of Perioperative Corneal Injury

Journal of Academic Ophthalmology ◽

10.1055/s-0039-3400545 ◽

2019 ◽

Vol 11 (02) ◽

pp. e49-e53

Author(s):

Amanda L. Ely ◽

Mark Goerlitz-Jessen ◽

Ingrid U. Scott ◽

Erik Lehman ◽

Tabassum Ali ◽

...

Keyword(s):

Risk Factors ◽

Quality Improvement ◽

Chart Review ◽

Medical Center ◽

Academic Medical Center ◽

Retrospective Chart Review ◽

Corneal Injury ◽

Surgical Case ◽

Anesthesia Providers ◽

Academic Medical

Abstract Objective This article evaluates the effectiveness of an ophthalmology resident-led quality improvement (QI) initiative to decrease the incidence of perioperative corneal injury at an academic medical center Design Retrospective chart review. Methods A retrospective chart review was conducted of all surgical cases performed 6 months prior to, and 6 months after, implementation of an ophthalmology resident-led QI initiative at an academic medical center. The QI initiative (which focused on perioperative corneal injury awareness, understanding of risk factors, and presentation of an algorithm designed to prevent perioperative corneal injury) consisted of a lecture and distribution of educational materials to anesthesia providers. Data collected through the chart review included type of surgical case, presence of diabetes mellitus or thyroid disease, patient age and gender, patient positioning (supine, prone, or lateral), level of anesthesia provider training, length of surgical case, surgical service, type of anesthesia, and type (if any) of perioperative eye injury. The rates of perioperative corneal injury pre- versus post-initiative were compared. Results The rates of perioperative corneal injury pre- and post-initiative were 3.7 and 1.9 per 1,000, respectively (p = 0.012). Significant risk factors for perioperative corneal injury include longer duration of surgery (odds ratio [OR] 90–180 vs. < 90 minutes = 4.18, 95% confidence interval [CI] 1.43–12.18; OR > 180 vs. < 90 minutes = 8.56, 95% CI 3.01–24.32; OR > 180 vs. 90–180 = 2.05, 95% CI 1.17–3.58), patient position lateral > prone > supine (OR prone vs. lateral = 0.25, 95% CI 0.09–0.67; OR supine vs. lateral = 0.13, 95% CI 0.07–0.23), nonhead and neck surgeries (OR = 0.32, 95% CI 0.11–0.87), and surgery performed under the general surgery service (OR general surgery service vs. other subspecialty services = 6.50, 95% CI 2.39–24.76). Conclusions An ophthalmology resident-led QI initiative consisting of educating anesthesia providers was associated with a significant decrease in the rate of perioperative corneal injury.

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Undiagnosed obstructive sleep apnea as a predictor of 30-day readmission for brain tumor patients

Journal of Neurosurgery ◽

10.3171/2019.4.jns1968 ◽

2020 ◽

Vol 133 (3) ◽

pp. 624-629 ◽

Cited By ~ 1

Author(s):

Ian F. Caplan ◽

Gregory Glauser ◽

Stephen Goodrich ◽

H. Isaac Chen ◽

Timothy H. Lucas ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Brain Tumor ◽

Sleep Apnea ◽

Roc Curve ◽

Medical Center ◽

Academic Medical Center ◽

Quality Improvement Initiative ◽

C Statistic ◽

Obstructive Sleep ◽

Patient Health

OBJECTIVEObstructive sleep apnea (OSA) is known to be associated with negative outcomes and is underdiagnosed. The STOP-Bang questionnaire is a screening tool for OSA that has been validated in both medical and surgical populations. Given that readmission after surgical intervention is an undesirable event, the authors sought to investigate, among patients not previously diagnosed with OSA, the capacity of the STOP-Bang questionnaire to predict 30-day readmissions following craniotomy for a supratentorial neoplasm.METHODSFor patients undergoing craniotomy for treatment of a supratentorial neoplasm within a multiple-hospital academic medical center, data were captured in a prospective manner via the Neurosurgery Quality Improvement Initiative (NQII) EpiLog tool. Data were collected over a 1-year period for all supratentorial craniotomy cases. An additional criterion for study inclusion was that the patient was alive at 30 postoperative days. Statistical analysis consisted of simple logistic regression, which assessed the ability of the STOP-Bang questionnaire and additional variables to effectively predict outcomes such as 30-day readmission, 30-day emergency department (ED) visit, and 30-day reoperation. The C-statistic was used to represent the receiver operating characteristic (ROC) curve, which analyzes the discrimination of a variable or model.RESULTSIncluded in the sample were all admissions for supratentorial neoplasms treated with craniotomy (352 patients), 49.72% (n = 175) of which were female. The average STOP-Bang score was 1.91 ± 1.22 (range 0–7). A 1-unit higher STOP-Bang score accurately predicted 30-day readmissions (OR 1.31, p = 0.017) and 30-day ED visits (OR 1.36, p = 0.016) with fair accuracy as confirmed by the ROC curve (C-statistic 0.60–0.61). The STOP-Bang questionnaire did not correlate with 30-day reoperation (p = 0.805) or home discharge (p = 0.315).CONCLUSIONSThe results of this study suggest that undiagnosed OSA, as assessed via the STOP-Bang questionnaire, is a significant predictor of patient health status and readmission risk in the brain tumor craniotomy population. Further investigations should be undertaken to apply this prediction tool in order to enhance postoperative patient care to reduce the need for unplanned readmissions.

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Overweight and Obesity Among Adults Identifying on the Transgender Spectrum in Newark, NJ Between 2018 and 2020: A Retrospective Chart Review

Current Developments in Nutrition ◽

10.1093/cdn/nzab055_054 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 1244-1244

Author(s):

Joachim Sackey ◽

Michelle DallaPiazza ◽

Sari Bentsianov ◽

Diana Finkel

Keyword(s):

Chart Review ◽

Medical Center ◽

Academic Medical Center ◽

Retrospective Chart Review ◽

Overweight And Obesity ◽

Future Research ◽

Obesity Class ◽

Academic Medical ◽

White Majority ◽

Hormone Use

Abstract Objectives To assess levels of overweight and obesity among transgender adults receiving care in an academic medical center in Newark, NJ between 2018 and 2020. Methods We performed a retrospective review of electronic medical records of transgender adults (≥18 years) receiving care in an academic medical center in Newark, NJ from 2018 through 2020. We used CDC Body Mass Index (BMI) cut-offs to determine overweight or obesity. Results Of the 159 patients included in this study, the median age was 28 years (range 18–75 years), 47.8% were Black, 27.4% were LatinX and 24.8% were White. Majority (89.3%) were receiving gender-affirming hormones and 69.2% identified as transfeminine. One-third (34.6%) were current smokers, 35.2% had a diagnosis of depression and/or anxiety and 23.3% were living with HIV. BMI was not associated with gender identity, race, hormone use, smoking, HIV status, depression and/or anxiety. A higher proportion of transfeminine participants (31.8%) were HIV positive compared to 4.1% of those identifying as transmasculine. Median BMI of the sample was 26kg/m2, 26.4% were overweight and 32.7% obese. Of the 32.7% who were obese, 12.6% were classified as obesity class 1, 10.7% as obesity class 2, and 9.4% as obesity class 3. Conclusions In this retrospective chart review, almost 60% of all transgender adults were either overweight or obese. Future research is needed to further explore potential clinical implications of elevated weight, as well as the medical, social, psychological, and health behavior factors associated with overweight and obesity among transgender individuals. Funding Sources None.

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Gross Pathology of Routine Pediatric Tonsillectomy Specimens: Optimizing the Value of Patient Care

Otolaryngology ◽

10.1177/0194599818804191 ◽

2018 ◽

Vol 160 (2) ◽

pp. 339-342 ◽

Cited By ~ 1

Author(s):

Elizabeth A. Hobbs ◽

Joshua A. Hanson ◽

Robert G. Nicholas ◽

Benjamin R. Johnson ◽

Karen A. Hawley

Keyword(s):

Patient Care ◽

Chart Review ◽

Medical Center ◽

Academic Medical Center ◽

Retrospective Chart Review ◽

Pediatric Malignancy ◽

Academic Medical ◽

The Mean ◽

Pathologic Analysis ◽

Mean Charge

Objective This investigation seeks to evaluate the effect of gross pathologic analysis on our management of patients undergoing routine tonsillectomy and to evaluate charges and reimbursement. Study Design Retrospective chart review from 2005 through 2016. Setting Academic medical center. Subjects and Methods Participants were pediatric patients aged 14 years and younger undergoing tonsillectomy for either sleep-disordered breathing or tonsillitis, with tonsillectomy specimens evaluated by pathology, and without any risk factors for pediatric malignancy. Records were reviewed for demographics, surgical indications, and pathology. Abnormal reports prompted an in-depth review of the chart. Charges and reimbursement related to both hospital and professional fees for gross tonsil analysis were evaluated. Results From 2005 to 2016, 3183 routine pediatric tonsillectomy cases were performed with corresponding specimens that were sent for gross analysis revealing no significant pathologic findings; 1841 were males and 1342 were females. Ten cases underwent microscopy by pathologist order, revealing normal tonsillar tissue. The mean charge per patient for gross analysis was $60.67 if tonsils were together as 1 specimen and $77.67 if tonsils were sent as 2 separate specimens; respective reimbursement amounts were $28.74 and $35.90. Conclusions Gross pathologic analysis did not change our management of routine pediatric tonsillectomy patients. Foregoing the practice at our institution would eliminate $19,171.72 to $24,543.72 in charges and $9081.40 to $11,344.40 in reimbursement per year. Eliminating this test would improve the value of patient care by saving health care resources without compromising clinical outcomes.

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Obstructive Sleep Apnea in Children With Down Syndrome: Screening and Effect of Guidelines

Clinical Pediatrics ◽

10.1177/0009922819845333 ◽

2019 ◽

Vol 58 (9) ◽

pp. 993-999 ◽

Cited By ~ 1

Author(s):

Adam Hsieh ◽

Amir Gilad ◽

Kevin Wong ◽

Michael Cohen ◽

Jessica Levi

Keyword(s):

Obstructive Sleep Apnea ◽

Down Syndrome ◽

Sleep Apnea ◽

Medical Center ◽

Retrospective Chart Review ◽

Children With Down Syndrome ◽

Obstructive Sleep ◽

High Prevalence ◽

Screening Frequency ◽

The Impact

Previous studies have shown low rates of screening for obstructive sleep apnea in children with Down syndrome (DS), a high-prevalence population. Our study investigated the impact of the 2011 American Academy of Pediatrics guidelines, which recommends screening for obstructive sleep apnea with polysomnogram by age 4 years. We conducted a retrospective chart review of patients 0 to 18 years of age with DS seen at a medical center between 2006 and 2016. Polysomnogram screening frequency was investigated and compared pre- and post-guideline publication. A total of 136 participants were identified. Thirty-two percent (44/136) of children with DS were referred for polysomnogram, all of whom had symptoms. Although overall referral frequency was unaffected, completion frequency by age 18 years improved after publication (30% [21/69] vs 19% [13/67]; P < .05). Notably, polysomnogram completion frequency by age 4 years improved after guidelines publication compared with prior (25% [17/69] vs 0% [0/67]; P < .0001).

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Incidence of Lingual Tonsil Hypertrophy in Adults with and without Obstructive Sleep Apnea

Otolaryngology ◽

10.1177/0194599817740333 ◽

2017 ◽

Vol 158 (2) ◽

pp. 391-394 ◽

Cited By ~ 7

Author(s):

Jessica A. Tang ◽

Michael Friedman

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Chart Review ◽

Retrospective Chart Review ◽

Neck Circumference ◽

Lingual Tonsil ◽

Obstructive Sleep ◽

Significant Difference ◽

Tongue Position ◽

Tonsil Tissue

Objectives To characterize the incidence of lingual tonsil hypertrophy (LTH) in adults with and without obstructive sleep apnea (OSA) and to determine any potential correlation between them. Study Design Retrospective chart review. Setting Single-center database, September 2016 to April 2017. Subject and Methods Lingual tonsil grade (LTG) determined by awake endoscopy was collected as well as other physical examination findings, such as Friedman tongue position, palatine tonsil size, and neck circumference. STOP-BANG scores and polysomnography data were collected to characterize OSA. Incidence of clinically meaningful LTH (defined as LTG 3 and LTG 4) was compared between OSA and non-OSA groups. Results Ninety-three patient charts were studied in total. There was no significant difference between patients with and without OSA in the incidence of clinically meaningful LTH (OSA, 13.5%; non-OSA, 14.6%; P = .872). Patients with and without OSA were compared by grade: LTG 1, 13.5% (OSA) vs 35.6% (non-OSA); LTG 2, 73.1% (OSA) vs 48.8% (non-OSA); LTG 3, 13.5% (OSA) vs 14.6% (non-OSA). There were no significant correlations between OSA status and LTG (ρ = 0.190, P = .069). Conclusion The incidence of LTH is uncommon, even among those with OSA, and does not seem to differ between patients with and without OSA. Neck circumference appears to be a better clinical indicator than lingual tonsil tissue for the likelihood of a patient having OSA.

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IS THERE AN ASSOCIATION BETWEEN OBSTRUCTIVE SLEEP APNEA AND FRAILTY IN OLDER VETERANS WITH DIABETES?

Innovation in Aging ◽

10.1093/geroni/igz038.3447 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S949-S949

Author(s):

Jahan E Mahjabin ◽

Dhanya Baskaran ◽

Christopher Lewis ◽

Valeria C Baldivieso ◽

William Wohlgemuth ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Medical Center ◽

Frailty Index ◽

Retrospective Chart Review ◽

Apnea Hypopnea Index ◽

P Value ◽

Frailty Status ◽

Obstructive Sleep ◽

The Mean

Abstract Obstructive Sleep Apnea is a highly prevalent disease, where incidence increases with age. Individuals with chronic diseases such as diabetes and obesity are at risk of OSA increasing the risk of frailty. A retrospective chart review was conducted to study the association between OSA and frailty in older diabetic Veterans. Baseline polysomnography data for 91 patients ≥ 65 years was obtained from the electronic health records at the Miami VA Medical Center. Patients were screened for frailty from January 2016 to August 2017, and followed until October 2018. Patients were then dichotomized into frail (Frailty Index (FI) ≥.21) and non-frail (robust FI =<.10 and pre-frail FI ≥.10, <.21) groups. The mean participant age is 70.9 years, with (SD) of 4.8. The mean age for the frail group is 71.1 years, with a SD of 5.2. Mean age for the non-frail group is 70.5 years, with a SD of 4.2. Linear regression demonstrated a significant positive linear relationship between BMI (t=2.096 p-value= .039) and the frailty index. In binomial logistic regression, adjusting for covariates, BMI was associated with increased apnea severity (OR=1.139, 95% CI= 1.044-1.241), p=.003. However, no significant association was found between FI and apnea severity. The severity of OSA based on the Apnea-Hypopnea Index had no significant association with frailty status. However, the study demonstrated a significant association between obesity and frailty, where higher BMI coincided with higher frailty. Increasing BMI coincided with increased severity of OSA, suggesting that BMI acts as a possible confounder between frailty and OSA.

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