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Objectives: Surgical repair of nasal septal perforations (NSPs) is technically challenging. Advantages associated with endoscopic NSP repair (ENSPR) include enhanced visualization and its minimally invasive nature. Purely endoscopic techniques have successful outcomes with low morbidity. This study provides a review of clinical features, surgical techniques, and outcomes in patients who underwent ENSPR. Methods: A systematic review was conducted using PubMed/MEDLINE, Cochrane library, and Embase databases. Manual bibliography search produced additional articles. Studies reporting purely endoscopic approaches for NSP repair were included. Patient demographics, NSP size, etiology, repair strategy, incidence of closure, and follow-up were analyzed. Results: A total of 329 cases from 20 studies were included. The mean age was 37.2 years (range, 12.3-51 years) and 55.0% were male. Common etiologies were iatrogenic (n = 180, 60.0%), trauma (n = 66, 22.0%), and idiopathic (n = 36, 12.0%). The mean NSP size was 17.1 mm (range, 4-23). Repair techniques included unilateral random pattern flaps (n = 205, 62.3%), interposition grafts (n = 137, 41.6%), and unilateral axial pedicled local flaps (n = 81, 24.6%). 222 patients (67.5%) underwent a 2-layered repair, while 70 (21.3%) and 37 (11.2%) patients underwent single and 3-layered repairs, respectively. Successful closure was achieved in 296 patients (90.0%). When stratified by layers of repair, 65 single-layered (92.9%), 196 2-layered (88.3%), and 34 3-layered repairs (91.9%) were successful at a mean follow-up of 16.3 months (range, 3-31 months). Conclusions: ENSPR generally achieves NSP closure with high rates of success among varying types of repairs. Further studies may determine how clinical factors and surgical methods impact the likelihood of obtaining successful closure. [ABSTRACT FROM AUTHOR]

Background: To investigate the association between American Society of Anesthesiologists (ASA) physical status classification and rates of postoperative complications in patients undergoing facial fracture repair. Methods: Patients were divided into 2 cohorts based on the ASA classification system: Class I/II and Class III/IV. Chi-square and Fisher's exact tests were used for univariate analyses. Multivariate logistic regressions were used to assess the independent associations of covariates on postoperative complication rates. Results: A total of 3575 patients who underwent facial fracture repair with known ASA classification were identified. Class III/IV patients had higher rates of deep surgical site infection (P =.012) as well as bleeding, readmission, reoperation, surgical, medical, and overall postoperative complications (P <.001). Multivariate regression analysis found that Class III/IV was significantly associated with increased length of stay (P <.001) and risk of overall complications (P =.032). Specifically, ASA Class III/IV was associated with increased rates of deep surgical site infection (P =.049), postoperative bleeding (P =.036), and failure to wean off ventilator (P =.027). Conclusions: Higher ASA class is associated with increased length of hospital stay and odds of deep surgical site infection, bleeding, and failure to wean off of ventilator following facial fracture repair. Surgeons should be aware of the increased risk for postoperative complications when performing facial fracture repair in patients with high ASA classification. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study is to compare the number of citations received by open access articles versus subscription access articles in subscription journals in the Otolaryngology literature. Methods: Using the Dimensions research database, we examined articles indexed to PubMed with at least 5 citations published in 2018. Articles were included from Otolaryngology — Head and Neck Surgery, The Laryngoscope, JAMA Otolaryngology — Head and Neck Surgery, Annals of Otology, Rhinology, and Laryngology, and American Journal of Otolaryngology. Multivariate Poisson regression modeling was used to adjust for journal, article type, and topic. Practice guidelines, position statements, or retractions were excluded as potential outliers. Results: 137 open access articles and 337 subscription access articles meeting inclusion criteria were identified, with a median citation number of 8 (IQR 6-11). The most common article type was original investigation (82.5%), and the most common study topic was head and neck (28.9%). Open access articles had a higher median number of citations at 9 (IQR 6-13) when compared to subscription access articles at 7 (IQR 6-10) (P =.032). Open access status was significantly associated with a higher number of citations than subscription access articles when adjusting for journal, article type, and topic (β =.272, CI 0.194-0.500, P <.001). Conclusions: Although comprising a minority of articles examined in this study of subscription journals, open access articles were associated with a higher number of citations than subscription access articles. Open access publishing may facilitate the spread of novel findings in Otolaryngology. [ABSTRACT FROM AUTHOR]

Objectives: There is a paucity of data on postoperative infections after endoscopic sinus surgery and associated risk factors. Our objective was to evaluate a cohort of patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis to determine which perioperative factors may be associated with infection in the 30-day postoperative period. Methods: A retrospective cohort study of adults who underwent ESS at a tertiary academic medical center from 2015 to 2018 was performed. The primary outcome was incidence of postoperative infection, defined by identification of sinus purulence on nasal endoscopy necessitating antibiotics within 30 days of surgery. Independent variables collated included the result of postoperative cultures and use of perioperative antibiotics, oral corticosteroids, packing, and steroid-eluting stents. Statistical analysis involved bivariate analysis to identify variables that correlated with postoperative infection and subsequent multivariate logistic regression to identify independent risk factors. Results: Three hundred seventy-eight unique ESS cases performed in 356 patients were reviewed. The mean age was 46 years (range, 18-87). The most common indication for surgery was chronic rhinosinusitis without nasal polyposis. The postoperative infection rate was 10.1%. The most commonly cultured pathogen was Staphylococcus aureus. Multivariate logistic regression analysis showed that postoperative systemic corticosteroid use was the only risk factor independently associated with infection (OR 3.47 [95% CI 1.23-9.76], P =.018). Conclusion: The incidence of postoperative infection following ESS was 10.1%. The use of postoperative systemic corticosteroids independently increased the risk of infection by 3.47-fold. [ABSTRACT FROM AUTHOR]