Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P85

Patient Perception and Duration of Pain
After Microdirect Laryngoscopy
Amanda C. Hu, MD (Presenter); Oliver Brett, MBChB;
Trylon Matthew Tsang, MBBS
Objectives: Postoperative pain is an important part of the
patient's surgical experience. The proper assessment of pain is
the first step toward its proper management. Our objective
was to evaluate patient's pain perception and duration after
microdirect laryngoscopy (MDL).
Methods: A prospective cohort study was conducted from
June 2018 to July 2019 at a tertiary academic center. Adult
patients undergoing MDL were administered the short-form
McGill Pain Questionnaire (SF-MPQ) before surgery and on
postoperative day (POD) 1, 3, and 7. Clinical data were collected. Statistical analysis included Friedman test, Wilcoxon
signed ranks test, and multiple logistic regression.
Results: Among the 130 patients (mean age 52.6 years,
84 male) who participated in the study, 46.2% required analgesia but only 23.1% required opioids. Mild pain levels were
reported on SF-MPQ: sensory, affective, total score, present
pain intensity (PPI), and visual analog scale (VAS). Patients
reported a significant increase in pain on POD 1, with
decreases in pain on POD 3 and 7. Pain scores returned to
preoperative values for total and affective scores on POD 7
but remained significantly elevated for PPI, VAS, and sensory
score. None of the following factors were associated with
increased pain: age, sex, body mass index, Mallampati score,
Cormack score, laryngoscope used, type of MDL, time under
anesthesia, employment status, intubation, Voice Handicap
Index-10, and chronic pain history.
Conclusions: Although mild pain levels were reported after
MDL, the pain persisted for up to 7 days. No clinical factors
were found to be associated with increased pain. This study was
one of the few prospective studies evaluating pain after MDL.
Preoperative Prognosticators for
Tracheotomy Risk: A Multi-institutional
Case Series
Michael B. Montalbano (Presenter); Mahmoud I. Awad, MD;
Yael Bensoussan, MD; William Schaefer Leber; Scott Lamm;
Jonathan M. Bock, MD; Jennifer A. Anderson, MD; Lisa (Likun)
Tian; Victoria X. Yu; Michael J. Pitman, MD
Objectives: Tracheotomy is a common consult for the otolaryngologist. The risk of complications for a specific patient
is difficult to predict. This study aims to identify measurable
preoperative indicators that may reliably predict postoperative
complications.
Methods: This multi-institutional retrospective case series
includes adults undergoing elective tracheotomy for respiratory failure across 3 university medical centers between
January 2012 and August 2018. Logistic and Cox regressions
were used to compare demographics, physiologic parameters,
and comorbidities to complications in search of significant
associations.

P85
Results: Among the 439 tracheotomies performed, early
(<72 hours) and late (>72 hours) complication rates were
12.9% and 28.4%, respectively. The most common complications included infection, bleeding, and cardiac arrest. Ninety
patients (20.5%) died in the early or late postoperative period.
Mortality was 45% in patients with pulmonary hypertension
(P < .001), 43% in those with ejection fraction (EF) ≤40 (P <
.001), and 35% in those with abnormal right ventricle function (P = .001), more than doubling the rates seen in patients
without each of these findings. Similarly, those with abnormal left ventricle function saw an 8.7% rate of cardiac arrest
(P = .026) and 30.25% mortality (P = .015), compared with
3.12% and 18.67%, respectively, in those with normal
function.
Conclusions: Many critically ill tracheotomy candidates
experience significant rates of complications. Major risk factors for mortality include EF ≤40, pulmonary hypertension,
and abnormal ventricular function. Along with other physiologic parameters, the role of preoperative echocardiogram
should be strongly considered as a prognostic tool when riskstratifying patients to assess fitness for the procedure.
Profiles of Reflux Patients at the 24-Hour
pH-Impedance Monitoring: A European
Multicenter Prospective Study
Jérome R. Lechien, MD, PhD, MSc (Presenter); Francois
Bobin, MD; Vinciane Muls, MD; Charelle Salem, MD;
Alexandra Rodriguez Ruiz, MD; Didier Dequanter, MD, PhD;
Miheala Horoi, MD; Sven Saussez, MD, PhD
Objectives: The reflux episodes of patients with gastroesophageal reflux disease (GERD) usually occur after meals. To
date, the profile of reflux episodes of patients with laryngopharyngeal reflux (LPR) has not been extensively studied. The
profile of LPR patients at the hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH)
and the relationship between hypopharyngeal reflux episodes
(HRE) and pepsin saliva concentration were investigated.
Methods: Patients with LPR at the HEMII-pH were recruited
from 5 European hospitals from January 2018 to January 2020.
Throughout the HEMII-pH, saliva samples were collected
after breakfast, lunch, and dinner to measure pepsin saliva concentration. The LPR profile of patients was studied through a
breakdown of the HEMII-pH findings over the 24 hours of
testing. The relationship between pepsin saliva concentration
and HRE was studied through linear regression.
Results: A total of 180 patients completed the study. More
than 70% of HRE occurred outside the 1-hour postmeal times
and 20% and 7% of HRE occurred during the 1-hour postmeal
and nighttime, respectively. Most patients had regular HRE
throughout the day, irrespective of the meal times. There were
no differences regarding the types of LPR (acid, nonacid,
mixed). Patients with LPR and GERD mainly had acid LPR
and patients with nonacid/mixed LPR had a low proportion of
GERD. There were no significant associations between HRE
and pepsin saliva concentration.

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Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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