Chronic rhinosinusitis and endoscopic sinus surgery in children admitted for pulmonary exacerbations of cystic fibrosis

National Trends in Chronic Rhinosinusitis and Inpatient Sinus Surgery in Adults with Cystic Fibrosis

Objective

Given the recent dramatic changes in medical therapy for cystic fibrosis (CF), this study aims to describe temporal changes in chronic rhinosinusitis (CRS) and endoscopic sinus surgery (ESS) rates.

Methods

National Inpatient Sample (2004-2019; weighted estimates for 119,067 pediatric and 202,407 adult patients) was used to analyze adult (age ≥18 years) and pediatric patients with CF with pulmonary manifestations. Comorbid CRS, ESS rates, and extended length of stay (LOS, ≥75th percentile) were analyzed.

Results

The rate of CRS in both pediatric (14.1% vs 21.1%, P < .001) and adult (16.5% vs 40.9%, P < .001) patients increased. Rate of ESS in pediatric patients with CRS decreased from 25.3% to 3.4% (P < .001). A similar decline occurred in adults with CRS (12.3% vs 3.6%, P < .001). In multivariate analysis from 2015 to 2019, ESS and extended LOS were associated with admission in the Western United States (P < .001). CRS (OR 1.14, P = .002) and ESS (OR 1.78, P = .002) were independent predictors of extended LOS. Elective admission, primary insurance, race, and hospital teaching/location were significantly associated with ESS and extended LOS (P < .05).

Conclusion

Despite the increased prevalence of CRS in adults and pediatric patients with CF, rates of inpatient ESS have declined from 2004 to 2019. Patient and hospital factors affect undergoing ESS in 2015 to 2019. CRS and ESS are associated with extended LOS in recent years.

Pädiatrische Rhinologie

The following review article highlights key topics in pediatric rhinology that are currently the focus in research and at conferences as well as in the interdisciplinary discussion between otorhinolaryngologists and pediatricians. In particular, congenital malformations such as choanal atresia or nasal dermoid cysts are discussed, followed by statements on the current procedures for sinogenic orbital complications as well as on the diagnosis and therapy of chronic rhinosinusitis in children. Furthermore, updates on the role of the ENT specialist in the care for children with cystic fibrosis and primary ciliary dyskinesia are provided.

Higher mortality rates associated with Clostridioides difficile infection in hospitalized children with cystic fibrosis

OBJECTIVE(S)

To determine the association of Clostridioides difficile Infection (CDI) with in-hospital mortality, Length of Stay (LOS), and hospital charges among pediatric Cystic Fibrosis (CF) hospitalizations using a large nationally representative pediatric hospital database.

STUDY DESIGN

We identified Cystic Fibrosis-related hospitalizations during the years 1997 to 2016 in the Kids' Inpatient Database (KID) and compared in-hospital mortality, LOS, and hospital charges among hospitalizations with and without a coexisting diagnosis of C. difficile using logistic regression models for mortality and general linear models with gamma distribution and logarithmic transformation for LOS and hospital charges. We also evaluated temporal trends in the proportion of CF hospitalizations with concomitant CDI using data published triennially RESULTS: We analyzed 21,616 pediatric CF hospitalizations between the years 1997 to 2016 and found a total of 240 (1.1%) hospitalizations with concurrent CDI diagnosis. Adjusted analyses demonstrated an association of CDI with increased mortality (OR 5.2, 95% CI 2.5-10.7), longer LOS (46.5% increment, 95% CI 36.0-57.1), and higher charges (65.8% increment, 95% CI 53.5-78.1) for all comparisons. The proportion of CF hospitalizations with CDI increased over time from 0.64% in 1997 to 1.73% in 2016 (p < 0.001).

CONCLUSION(S)

As CDI is associated with excess mortality, LOS, and cost in children hospitalized for CF, a healthy level of suspicion for CDI may be needed in patients with CF in the appropriate clinical context. Efforts to prevent, diagnose, and treat CDI may improve hospital outcomes among children with CF.