Prone versus modified supine percutaneous nephrolithotomy: which is more cost effective in an Australian tertiary teaching hospital?

Introduction: Percutaneous nephrolithotomy is currently one of the main treatment options for large renal stones, but the effect of positioning on comparative costing has been scarcely documented. We aimed to compare the cost effectiveness of modified supine with traditional prone percutaneous nephrolithotomy procedures in the context of Victoria, Australia. Materials and methods: A prospective group of 236 renal units (224 patients) was included in the two-site study, with 76 performed in the prone position and 160 performed in the modified supine position. Costing was calculated using a ‘bottom-up’, all-inclusive framework that generates per-hour costs for theatre, recovery unit and ward costs from base costs and maintenance costs. Percutaneous nephrolithotomy-specific equipment was added to calculate comparative costs of modified supine versus prone procedures. Chi squared and T tests were used for statistical analysis. Results: There was a significant difference in the overall costing between the modified supine and prone groups. The modified supine group had a lower total cost (AUD$6424.29) compared to the prone group (AUD$7494.79) ( P=0.007), lower operative costs (AUD$4250.93 vs. AUD$5084.29, P=0.002) and lower ward costs (AUD$533.55 vs. AUD$1130.20, P<0.001). There was no significant difference in recovery times in the modified supine and prone groups, although the modified supine group appeared to have shorter recovery times (AUD$690.69 vs. AUD$586.05, P=0.209). Conclusions: Modified supine percutaneous nephrolithotomy has significantly lower total costs, operative costs and ward costs compared to prone percutaneous nephrolithotomy. Larger randomised trials are needed to assess these findings further. Level of evidence: Not applicable for this multicentre audit.

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Shock-wave lithotripsy, ureterorenoscopy and percutaneous nephrolithotomy for 1–2 cm renal stones: A randomised pilot study

Journal of Clinical Urology ◽

10.1177/2051415820935663 ◽

2020 ◽

Vol 13 (6) ◽

pp. 413-418

Author(s):

Philip J McCahy ◽

Matthew Hong ◽

Eldho Paul ◽

Ivor Berman ◽

Shekib Shahbaz

Keyword(s):

Shock Wave ◽

Percutaneous Nephrolithotomy ◽

Shock Wave Lithotripsy ◽

Renal Stones ◽

Level Of Evidence ◽

Extracorporeal Shock Wave ◽

Stone Free Rate ◽

Computed Tomography Scanning ◽

Significant Difference ◽

Free Rate

Objectives: This study aimed to assess which of extracorporeal shock-wave lithotripsy (SWL), ureterorenoscopy (URS) or percutaneous nephrolithotomy (PCNL) offers the best stone-free rate (SFR) for 1–2 cm renal stones. Patients and methods: A total of 31 patients with renal stones between 1 and 2 cm were randomised to SWL, URS or PCNL. Repeat treatments or alternatives were performed until the patient was stone free or clinically in no further need of treatment. All patients were assessed with computed tomography scanning independently reviewed by a radiologist blinded to the treatment. Results: Overall, 10 well-matched patients were randomised to SWL, 11 to URS and 10 to PCNL. SFRs were 60% for SWL, 55% for URS and 80% for PCNL (no significant difference). The mean number of procedures required were 2.6 (range 1–7) for SWL, 2.5 (range 1–4) for URS and 1.3 (range 1–3) for PCNL ( p=0.072). There were no major complications, but 50% of SWL had minor complications compared with 9% for URS and 20% for PCNL. Conclusion: The results for SWL were disappointing for SFR, number of procedures and complications. In common with other recent studies, the SFR following URS was also poor. PCNL had the best results for SFR with the fewest procedures. We calculate that an adequately powered study will require 42 patients per arm. Level of evidence Level 2b

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Complications and surgical results of stone-directed antegrade pyelography compared to the retrograde pyelographic access method in percutaneous nephrolithotomy using ‘bull’s eye’ technique: A randomized clinical trial

Journal of Clinical Urology ◽

10.1177/2051415821993729 ◽

2021 ◽

pp. 205141582199372

Author(s):

Dariush Irani ◽

Abdolreza Haghpanah ◽

Mohammad Mehdi Hosseini ◽

Leila Malekmakan ◽

Mohammad Ali Ashraf ◽

...

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Percutaneous Nephrolithotomy ◽

Renal Stones ◽

Surgical Results ◽

Retrograde Pyelography ◽

Antegrade Approach ◽

Antegrade Pyelography ◽

Significant Difference ◽

Bull's Eye

Objectives: This study aimed to evaluate the differences in outcomes and complications in stone-directed antegrade pyelography using the ‘bull’s eye’ technique in patients with renal stones versus the conventional method of percutaneous nephrolithotomy (PCNL). Although conventional PCNL access using retrograde pyelography is useful, it is time-consuming and may cause postoperative discomfort. Herein, we report our experience in the application of this new technique. Methods: Between January 2017 and June 2018, 100 patients participated in this randomized clinical trial. Stone-directed antegrade pyelography using the ‘bull’s eye’ technique under fluoroscopic guidance was used for percutaneous access in the intervention group. The second group, consisting of those who had undergone conventional PCNL using retrograde pyelography and ‘bull’s eye’ technique in the same period, were considered as the controls. Pre- and postoperative laboratory examinations, surgical results and complications were recorded and compared between the two groups. Results: A single calyceal puncture in partial staghorn and staghorn stone patients was sufficient in 72.2% of the antegrade group and in 78.9% of the retrograde group ( p=0.69). The double-puncture technique was necessary for 71.9% of renal pelvis stones in the antegrade group and for 9.4% in the retrograde group ( p<0.001). The antegrade approach reduced the mean operative time and analgesic requirement significantly ( p<0.001). No statistically significant difference, however, was found between the two groups regarding stone migration to the ureter, radiation time and postoperative complications. Conclusions: The stone-directed antegrade approach using the ‘bull’s eye’ technique is a safe and accurate method in PCNL access in patients with radiopaque and semi-opaque renal stones.

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Efficacy of Percutaneous Nephrolithotomy in the Treatment of Renal Calculi of 10 to 20 MM Size: A Comparison With Extracorporeal Shock Wave Lithotripsy

Bangladesh Journal of Urology ◽

10.3329/bju.v21i2.49881 ◽

2020 ◽

Vol 21 (2) ◽

pp. 98-104

Author(s):

Muhammad Mahmud Alam ◽

Mohammad Rezaul Karim ◽

Mohammad Ohiduzzaman Khan ◽

Mohammad Mukhlesur Rahman ◽

Mahfuja Asma ◽

...

Keyword(s):

Shock Wave ◽

Percutaneous Nephrolithotomy ◽

Extracorporeal Shock Wave Lithotripsy ◽

Shock Wave Lithotripsy ◽

Renal Stones ◽

Renal Calculi ◽

Post Procedure ◽

Extracorporeal Shock Wave ◽

Significant Difference

Background: Stones in the urinary tract is a common medical problem in the general population. At present, the great expansion in minimally invasive techniques has led to the decrease in open surgery. Extracorporeal shock wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the kidney and upper urinary tract through the use of shock waves. Nevertheless, as there are limitations with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous nephrolithotomy (PCNL) is also widely applied. There is a trend of using ESWL for treatment of renal stones smaller than 1 cm and PCNL in those with stones greater than 2 cm. Nevertheless, no consensus regarding treatment of renal stones between 1 to 2 cm stones. The objective of this prospective study was to compare the results of ESWL and PCNL for treatment of 1 to 2 cm renal stones. Method : This is a quasi experimental study. This study was conducted to compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) in treating 10 to 20 mm sized renal stone among the Bangladeshi population. This prospective study conducted between the periods of September, 2011 to August, 2012 in the department of urology, Bangabandhu Sheikh Mujib medical university (BSMMU) Hospital. All the patients attending the urology outpatient clinic with 10 to 20mm renal calculi were the study population. A total of 70 subjects were enrolled for this study and they were equally divided into two groups so that each group had 35 subjects. The one group received PCNL whereas the other group received ESWL. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-15). Results: There is no statistically significant difference in regarding age, sex, stone side(lt. or rt.), the distribution of stone (upper, middle and lower calyx) and size between the groups (p>0.05). At 3 month follow up among the patients in ESWL group stone cleared and not cleared were 25(71.4%) and 10(28.6%) respectively and at 3 month follow up among the patients in PCNL group stone cleared and not cleared were 33(94.3%) and 2(5.7%)respectively. There is statistically significant difference in stone clearance rate at 3 month follow up between the groups (p<0.05). All patients in ESWL group developed post procedure haematuria 35(100.0%). Other post procedure complications among the ESWL group pain, fever and steinstrasse were 12(34.3%), 07(20.0%) and 03(08.6%) respectively. Common post procedure complications among the patients of PCNL group pain, haematuria and fever were 11(31.4%), 33(94.3%) and 13(37.1%) respectively. Other post procedure complications in PCNL group were vomiting (8.6%), urinary leakage (5.7%), wound infection (11.4%) and urinary cutaneous fistula (5.7%). There was no statistically significant difference post procedure pain, haematuria and fever between the groups (p>0.05), but statistically significant difference observed in steinstrasse and wound infection between the groups (p<0.05). Mean±SD of hospital stay among the patients of ESWL group and PCNL group was 1.37±0.65 and 4.34±1.43 days respectively. There is statistically significant difference in hospital stay between the groups (p<0.05). Conclusion: Though some specific complications which can be treated conservatively are more in PCNL group it may be concluded that the treatment with PCNL is better option than ESWL among the patients having renal calculi 10 to 20 mm. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.98-104

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Tubeless Percutaneous Nephrolithotomy with Hemostatic Plug Using Surgiflo® versus Standard Percutaneous Nephrolithotomy using a Nephrostomy Tube: A Prospective Randomized Controlled Study

QJM ◽

10.1093/qjmed/hcab110.010 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Hisham Mohamed Fathey Elshawaf ◽

Mohamed Ismail Shabayek ◽

Mohamed Ahmed Saleh Ahmed

Keyword(s):

Percutaneous Nephrolithotomy ◽

Intraoperative Complications ◽

Demographic Data ◽

Renal Stones ◽

Controlled Study ◽

P Value ◽

Nephrostomy Tube ◽

Gelatin Matrix ◽

Significant Difference ◽

Tubeless Pcnl

Abstract Background Percutaneous Nephrolithotomy (PCNL) is the preferred technique for treating large renal stones (over 2cm in diameter). It involves keyhole surgery performed through a small skin incision overlying the kidney. Objectives Our study aimed at evaluating the safety and efficacy of local hemostatic sealant (surgiflo®) use in tubeless PCNL to enhance postoperative outcomes of PCNL. Patients and Methods We randomized our patients into two groups, Group A nephrostomy tube was used as standard PCNL, and at group B tubeless PCNL was done followed by injection of the local hemostatic flowable gelatin matrix (surgiflo®) under fluoroscopic guidance in the prone position Results There was no statistically significant difference between two groups regarding demographic data age, sex and BMI (P- value 0.280, 0.736 and 0.440 respectively), stone site and size (P- value 0.525 and 0.533 respectively), operative time (P- value 0.855), intraoperative complications as blood loss and pelvicalyceal perforation, (P- value 0.92 and P- value 0.83 respectively), postoperative complication as fever, haematuria and UTI (P- value 1.000, 0,113 and 1.000 respectivly), and Hb drop (P- value 0.735). Conclusion Tubeless PCNL with hemostatic sealant use is associated with less pain, no leakage from nephrostomy tract, less narcotic agent use, and a shorter hospital stay.

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P144: Assessment of the quality of evidence presented at the Canadian Association of Emergency Physicians annual meeting over a five-year period (2013-2017)

CJEM ◽

10.1017/cem.2018.342 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S108-S108

Author(s):

V. Srivatsav ◽

B. Zhang ◽

I. Nadeem ◽

S. Upadhye ◽

Michael G. Degroote

Keyword(s):

Emergency Medicine ◽

Annual Meeting ◽

Data Extraction ◽

Level Of Evidence ◽

Canadian Association ◽

Predominant Type ◽

Significant Difference ◽

Chi Squared ◽

Level I ◽

Economic Analyses

Introduction: The CAEP annual meeting presents the latest evidence for clinical practice, but there has not yet been an appraisal of the abstracts presented at this conference. Therefore, we sought to evaluate the level of evidence of research presented at the annual meeting, and assess for trends over a five-year period (2013-2017). Methods: We conducted a scoping review that included all CAEP abstracts from 2013-2017, obtained through the Canadian Journal of Emergency Medicine. Two reviewers assessed eligibility and extracted data from abstracts individually, with conflicts resolved by a third reviewer. Qualitative research was excluded. Extracted data included type of presentation (ex. oral, poster), sample size, study design and type of study (therapeutic, prognostic, diagnostic, education, quality improvement, or systems-wide/economic analyses research). A level of evidence (LOE) was assigned using the 2011 Oxford Centre for Evidence-Based Medicine criteria. Results: Abstracts from 2014-2017 have been analyzed thus far, 1090 of which were eligible and 990 included. Inter-rater agreement for screening and data extraction was high ( value 0.87 and 0.84 respectively). Systems-wide/economic analyses research was the predominant type of study (28.6%, 283/990), followed by therapeutic (19.9%, 197/990) and education (19.9%, 195/990). The mean LOE was 2.81 (95% CI 2.77,2.85). The highest proportion of studies were of level III evidence (77.7%, 769/990), followed by level II (9.6%, 95/990) and level I evidence (7.8%, 77/990). 72.1% (124/172) of all level I and II abstracts were presented in 2016 and 2017. A significant change in LOE between years was evident (p<0.0001, chi-squared). The greatest proportion of level I and II abstracts were lightning oral (41.9%, 72/172), followed by posters (36.0%, 62/172). The best average LOE was observed for lightning oral (2.64, 95% CI 2.56, 2.72), with the poorest average LOE witnessed for moderated posters (2.90, 95% CI 2.83, 2.97). A significant difference was present in mean LOE between types of presentations (p<0.0001, one-sided ANOVA). Conclusion: The majority of abstracts were level III evidence. The lightning oral sessions had the greatest proportion of level I and II evidence presented. Recent years of the conference have also seen the presentation of a greater number of level I and II evidence, which may suggest a shift towards generating and disseminating higher level evidence in emergency medicine.

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Antidepressant augmentation and combination in unipolar depression: strong guidance, weak foundations

Irish Journal of Psychological Medicine ◽

10.1017/s0790966700011800 ◽

2011 ◽

Vol 28 (4) ◽

pp. i-ix ◽

Cited By ~ 1

Author(s):

Erik Kolshus ◽

Leonard Douglas ◽

Ross Dunne

Keyword(s):

Depressive Disorders ◽

Treatment Options ◽

Tertiary Care ◽

Treatment Strategies ◽

Case Series ◽

Clinical Excellence ◽

Unipolar Depression ◽

Cost Effective ◽

Level Of Evidence ◽

Levels Of Evidence

Depression will be the second leading contributor to the global burden of disease by 2020. In Ireland, in 2009, 6061 people were hospitalised with depressive disorders. This represents a significant economic and social burden. There is growing awareness of the difficulty in treating depression with medications alone. The likelihood that a patient will achieve remission with the first antidepressant tried is around 30%, and the rates are similar for the second antidepressant tried. This falls to around 15% after three trials. Many patients are exposed to pharmacotherapy for extended periods of time with little beneficial effect, but often with side-effects. Patients are therefore in great need of clear information with regard to their chance of success. Clinicians are in need of clear guidance on prescribing strategies which have proven efficacy. However, this guidance often discusses treatment strategies based on varying levels of evidence. Guiding bodies may approach the problem from varying perspectives. The UK National Institute for Health and Clinical Excellence (NICE) has a clear government mandate with regard to provision of not only effective but cost-effective treatments. The British Association of Psychopharmacology (BAP) is an independent body of interested researchers and therefore may discuss prescribing options from the point of view of tertiary care institutions, and university centres. The South London and Maudsley NHS Foundation Trust publish the popular Maudsley guidelines. These are perhaps more pragmatic in nature, but include very low levels of evidence, including case series.The American Psychiatric Association (APA) is an independent member association which also publishes guidelines. These are published in the American Journal of Psychiatry and the latest guidelines were published in October 2010.All these bodies attempt to weigh their advice according to the level of evidence available and aim to provide clinical guidance in difficult situations. The burden on guiding organisations is to provide some direction and clarity in areas that are often unclear or controversial. Clinical guidelines are one method of providing support and guidance to busy clinicians. However, this clinician-centered approach has limitations. The onus is on the authors of the guidance to provide ever-more treatment options. This may mean that conclusions about the efficacy of medications is overstated or the limitations of the literature not fully explored in explanatory notes.

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Back to Basics: Could the Preoperative Skin Antiseptic Agent Help Prevent Biofilm-Related Capsular Contracture?

Aesthetic Surgery Journal ◽

10.1093/asj/sjy216 ◽

2018 ◽

Vol 39 (8) ◽

pp. 848-859 ◽

Cited By ~ 7

Author(s):

Jenny Carvajal ◽

Melissa Carvajal ◽

Gilma Hernández

Keyword(s):

Breast Augmentation ◽

Capsular Contracture ◽

Bacterial Biofilm ◽

Skin Microbiome ◽

Level Of Evidence ◽

Clinical Safety ◽

Skin Preparation ◽

Significant Difference ◽

Chi Squared ◽

Healthcare Epidemiology

AbstractBackgroundCapsular contracture (CC) has remained an unresolved issue throughout history. Strong evidence focuses on bacterial biofilm as its main source. A literature review revealed that more than 90% of bacteria found in capsules and implants removed from patients with Baker grade III-IV CC belong to the resident skin microbiome (Staphylococcus epidermidis, predominant microorganism). The use of an adequate preoperative skin antiseptic may be a critical step to minimize implant contamination and help prevent biofilm-related CC.ObjectivesThe authors sought to compare the effect of 2 different antiseptic skin preparations: povidone-iodine (PVP-I) vs chlorhexidine gluconate (CHG) on CC proportions after primary breast augmentation through a periareolar approach.MethodsIn June of 2014, The Society for Healthcare Epidemiology of America proposed to use CHG for preoperative skin preparation in the absence of alcohol-containing antiseptic agents as strategy to prevent surgical site infection. The clinical safety committee of a surgical center in Colombia decided to change PVP-I to CHG for surgical site preparation thereafter. The medical records of 63 patients who underwent to primary breast augmentation through a periareolar approach during 2014 were reviewed. In the first 6 months PVP-I was used in 32 patients, and later CHG was employed in 31 patients.ResultsPearson’s chi-squared test to compare CC proportions between subgroups showed a statistically significant difference. The CC proportion was higher for patients who had antisepsis with PVP-I. CC was absent when CHG was employed.ConclusionsCHG as preoperative skin antiseptic for primary breast augmentation surgery was more effective than PVP-I to help prevent biofilm-related CC.Level of Evidence: 3

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Percutaneous nephrolithotomy versus flexible ureteroscopy in terms of cost-effectiveness in patients with 10–30 mm renal stones

Urologia Journal ◽

10.1177/0391560319876805 ◽

2019 ◽

Vol 87 (1) ◽

pp. 41-46

Author(s):

Abdullah Erdoğan ◽

Ercüment Keskin ◽

Abdulsemet Altun

Keyword(s):

Percutaneous Nephrolithotomy ◽

Renal Stones ◽

Flexible Ureteroscopy ◽

Common Disease ◽

Retrograde Intrarenal Surgery ◽

Total Cost ◽

Extracorporeal Shock Wave ◽

Significant Difference ◽

The Cost ◽

Mean Cost

Purpose: Kidney stones are one of the most common urological problems. When deciding on the method of treatment for this common disease, the cost of the procedure should also be taken into consideration. Materials and methods: We performed a retrospective analysis of 55 patients who underwent percutaneous nephrolithotomy and 75 patients who underwent retrograde intrarenal surgery between January 2016 and November 2018. Until operative success was achieved, all additional surgical procedures, extracorporeal shock wave lithotripsy procedures, and interventional procedures required to resolve complications were recorded. Total cost was compared between the percutaneous nephrolithotomy and retrograde intrarenal surgery groups. Results: No significant difference was found between the percutaneous nephrolithotomy and retrograde intrarenal surgery groups in terms of gender, mean age, stone side, stone localization and stone surface area. The total cost of 55 patients that underwent percutaneous nephrolithotomy was calculated as US$14.766 after the first operation, and the total cost of 75 patients that underwent retrograde intrarenal surgery was determined to be US$46.627. The mean cost per patient was calculated US$320 ± US$186 for percutaneous nephrolithotomy and US$749 ± US$242 for retrograde intrarenal surgery (p < 0.001). Conclusions: Percutaneous nephrolithotomy is a lower-cost and successful method in the surgical treatment of 1–3 cm stones, but the serious complications involved in this operation should be kept in mind.

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Percutaneous nephrolithotomy versus open surgery for treatment of staghorn stones in pediatric patients

Canadian Urological Association Journal ◽

10.5489/cuaj.1994 ◽

2014 ◽

Vol 8 (11-12) ◽

pp. 906 ◽

Cited By ~ 4

Author(s):

Ahmed R. EL-Nahas ◽

Ahmed A Shokeir ◽

Ahmed M Shoma ◽

Ibrahim Eraky ◽

Osama M Sarhan ◽

...

Keyword(s):

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Open Surgery ◽

Renal Stones ◽

Small Sample ◽

Stone Free Rate ◽

Significant Difference ◽

Group 2 ◽

Free Rate ◽

Staghorn Stones

Introduction: We compare percutaneous nephrolithotomy (PCNL) and open surgery in the treatment of staghorn stones in children.Methods: We retrospectively reviewed the electronic records of children who underwent treatment for staghorn stones between September 2000 and August 2013. They were divided between Group 1 (patients who underwent PCNL) and Group 2 (patients who underwent open surgery). We compared stone-free and complications rates, need for multiple procedures, and hospital stay.Results: The study included 41 patients (35 boys and 6 girls), with mean age 7.4 ± 3.1 years (range: 2–15). Of these 41 patients, 26 had unilateral renal stone and 15 had bilateral renal stones. The total number of treated renal units was 56: 28 underwent PCNL and 28 underwent open surgery. The complication rate was comparable for both groups (32% for open surgery vs. 28.6%, p = 0.771). Multiple procedures were more needed in PCNL group (60.7% vs. 32% in open surgery, p = 0.032). The stone-free rate was 71.4% after PCNL and 78.6% after open surgery (p = 0.537). A significant difference was observed in shorter hospital stay after PCNL (5 vs. 8.8 days, p < 0.001). Our study’s limitations include its retrospective design and relatively small sample size.Conclusions: For the treatment of staghorn stones in children, PCNL was comparable to open surgery in complication and stone-free rates. PCNL had the advantage of a shorter hospital stay and open surgery showed a decreased need for multiple procedures.

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On the effectiveness of treatment options in epistaxis: an analysis of 678 interventions

Rhinology Journal ◽

10.4193/rhino10.313 ◽

2011 ◽

Vol 49 (4) ◽

pp. 474-478

Author(s):

M.B. Soyka ◽

G. Nikolaou ◽

K. Rufibach ◽

D. Holzmann

Keyword(s):

Retrospective Cohort ◽

Health Care Systems ◽

Financial Burden ◽

Treatment Options ◽

University Hospital ◽

Level Of Evidence ◽

Significant Difference ◽

The World ◽

Care Systems ◽

The University

Background: Epistaxis represents one of the most common emergencies in ENT clinics around the world. It creates great physical and emotional stress to the patient as well as a financial burden on health-care systems. A lot of research has been performed with regard to aetiology and possible treatment, however, not much effort has been put into analysing the effectiveness of common treatment forms. It is the objective of this study to clarify which of these treatment forms is reliable. Study design: Retrospective cohort study. Level of evidence: 2b. Methods: Between 03/2007 and 04/2008, all epistaxis therapies including relapses and treatment failures at the University Hospital of Zurich have been documented using a computerised questionnaire. Different treatments were compared to each other. Results: An analysis of 678 interventions in 537 patients was performed with emphasis on failure proportions and time to occurrence. The estimated failure proportions of coagulation in anterior epistaxis accounts for 14%. Successful treatment of epistaxis in posterior bleedings could be achieved in 62% by packing and in 97% by surgery with a statistically significant difference between the respective groups. Conclusion: Using our treatment options, anterior epistaxis can be cured reliably by cauterisation. Surgical therapies in posterior bleedings are able to successfully salvage failed packing therapies.

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