The annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundation was held from Oct. 7 to 10 in Atlanta and attracted more than 5,500 participants from around the world, including otolaryngologists, medical experts, allied health professionals, and administrators. Presentations focused on the latest advances in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck.
In one study, Jocelyn L. Kohn, M.D., of the Boston Medical Center, and colleagues found that high numbers of children fail to complete sleep studies, which poses delays to treatment of their sleep disordered breathing.
“In our study of 829 patients, almost a quarter of our pediatric patients failed to complete an ordered sleep study,” Kohn said. “Of the demographic factors examined, only age proved by univariate and multivariate analyses to be a significant factor associated with completion of sleep studies.”
The investigators also found that teenagers were significantly less likely than toddlers to complete the sleep study. Race was not statistically significant, but there was a trend toward Hispanic patients having the highest rates of sleep study completion. The investigators found no significant association between primary language or insurance status and completion of the sleep studies.
“Clinically, we should be asking parents (and patients in the case of our teenagers) if they actually intend to complete a recommended sleep study to reduce the number of patients lost to follow-up in the work-up of sleep disordered breathing,” Kohn said. “We should also consider the option of up-front surgery for those patients who are unlikely to follow through with an ordered polysomnogram.”
In another study, Alex Rock, M.D., of The Ohio State University Wexner Medical Center in Columbus, and colleagues evaluated postoperative opioid prescriptions and opioid use following nasal surgery (septoplasty or rhinoplasty).
“The opioid epidemic in our country continues to run rampant and there is evidence that prescription opioids are a contributing factor,” Rock said. “A retrospective chart review and telephone survey was performed for patients who had undergone surgery over a 12-month period.”
The investigators found no significant difference in the amount of opioids used when looking at gender, type of surgery (septoplasty versus rhinoplasty), surgeon, use of Doyle splints, or whether over-the-counter pain medications were utilized.
“We found that we were, on average, prescribing nearly three times the amount of opioids that were used by the patient,” Rock added. “We, along with many other surgical subspecialties, are over-prescribing narcotics in the postoperative setting. We are now making a significant effort to reduce the number of opioid tablets prescribed in the postoperative setting with the use of a multimodal analgesia protocol (scheduled Tylenol and ibuprofen).”
Saral Mehra, M.D., of the Yale School of Medicine in New Haven, Conn., and colleagues examined the association between payments from industry associated with brand-name nasal steroids and physician preferential prescribing of certain brand-name products over generic and over-the-counter products.
“We used the Open Payments Database and Medicare part D prescription drug files,” Mehra explained. “We identified industry payments mainly in the form of meals, speaking fees, and consulting fees that were associated with individual brand-name nasal steroids and examined the percentage of prescriptions written for those brand-name drugs.”
The investigators found that physicians receiving industry compensation were significantly more likely to prescribe brand-name drugs and to prescribe the brand-name drugs at a higher rate than physicians not receiving payments.
“This was true even though most payment amounts were typically under $100,” Mehra said. “Physicians should be aware of the potential conflicts of interest that even minor industry interaction can cause.”
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