The Association of Same-Day CT Scan with Post-Operative Outcomes in Isolated Orbital Fracture Repair

During isolated orbital fracture reconstruction, the use of intraoperative and/or same-day computed tomography (CT) scans has been debated due to potential effects on patient outcomes. Previous research in this field has been limited by small sample sizes. This retrospective study, which drew from IBM MarketScan Commercial and Medicare Supplemental research databases, examined patients who underwent isolated orbital reconstruction from 1/1/2012 to 12/31/2018, aiming to ascertain whether same-day CT scans could decrease negative postoperative outcomes. Among the 5023 participants, the average age was 37 (SD of 16) years and 63% were male. The data revealed that 16.2% (815 of 5023) had a same-day CT. Those who underwent a same-day CT scan exhibited reduced odds of post-operative enophthalmos (aOR: 0.269 [95% CI, 0.167-0.433]) and diplopia (aOR, 0.670 [95% CI, 0.495-906]). Contrarily, these patients also displayed a heightened rate of revision surgeries (aOR: 2.721, [95% CI, 1.893-3.912]). In summary, while same-day CT scans during orbital fracture repair seem beneficial in diminishing certain post-operative complications, they are also associated with an increased likelihood of subsequent surgical revisions.

Intraoperative Computed Tomography Use in Orbital Fracture Repair: A Systematic Review and Meta-Analysis

Background: Intraoperative computed tomography (CT) allows surgeons to make adjustments during orbital fracture repair that may impact postoperative outcomes. Learning/Study Objectives: To determine the impact of intraoperative CT use on intraoperative revision and surgical outcomes for orbital fracture repair. Methods: A systematic review was performed in concordance with the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines: the population was patients undergoing orbital fracture repair; intervention was use of intraoperative CT; comparison was patients not undergoing intraoperative CT; and outcomes were intraoperative revision rate, postoperative complications, and secondary revision surgeries. Meta-analysis was performed on the rate of intraoperative revision. Results: The search criteria yielded 790 articles, 377 were eligible for review, and 20 articles met criteria for analysis. In 19, intraoperative imaging led to immediate surgical corrections, with a random pooled effect size of 0.27 (0.20-0.35). Six studies reported secondary revision surgery rates (range 0-10.5%), and six studies reported postoperative complication rates (range 10-30%). Conclusions: Intraoperative imaging helps surgeons make precise, real-time adjustments in 27% of orbital fracture repair cases, which may improve surgical outcomes; however, more research is needed to investigate its impact on health care costs, operating time, and radiation exposure.

Correlation Between a Diagnosis of Anxiety or Depression and Initial VHI-10 Scores in Benign Dysphonia

OBJECTIVE

Anxiety and depression have demonstrated a positive correlation with vocal handicap among patients with benign causes of dysphonia. Our objective is to explore differences in initial Vocal Handicap Index-10 (VHI-10) scores between patients with a mental health history of anxiety or depression and those without.

STUDY DESIGN

Retrospective cohort study.

SETTING

Demographic data, diagnoses, and initial VHI-10 scores were collected for patients presenting with dysphonia to 2 tertiary laryngology clinics.

METHODS

A Kruskal-Wallis test and subsequent Mann-Whitney U test for pairwise comparisons were used to compare distribution of VHI-10 scores among patients with anxiety, depression, anxiety and depression, and no such conditions. Bonferroni correction was used to control for multiple comparisons. Robust regression was used for multivariable analysis.

RESULTS

A total of 620 cases of benign dysphonia were analyzed. Forty-two percent of the patient cohort had a preexisting diagnosis of anxiety (n = 121, 20%), depression (n = 64, 10%), or anxiety and depression (n = 74, 12%). VHI-10 scores were higher in patients with depression than in those without anxiety or depression (median difference, 4 [95% CI, 1-8]; P = .005) but did not differ significantly among the other groups. The effects of depression and anxiety status on initial VHI-10 scores among the causes of benign dysphonia varied.

CONCLUSIONS

Patients with a history of depression who presented with dysphonia had worse vocal handicap than those without anxiety/depression history. Future studies may clarify how optimization of anxiety and depression can affect patient-reported vocal handicap.