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Gupta MK, Misariu AM, Saydy N, Nichols AC, Laxague F, Eskander A, Li H, Weisbrod N, Pasternak JD, Golbon B, Jin E, van Uum SHM, Brassard M, Lévesque F, Sadeghi N, Subramaniam T, Mlynarek AM, Morand GB, Fortier PH, Fradet L, Ghaznavi S, Chandarana SP, Prisman E, Ayad T, Christopoulos A, Davies JC, Rajaraman M, Corsten M, Rajaraman K, Maniakas A. A Multicentre Retrospective Study of Anaplastic Thyroid Cancer in the Era of Targeted Therapy in a Public Health Care System: Canada's Experience. Thyroid 2023; 33:1374-1377. [PMID: 37725592 DOI: 10.1089/thy.2023.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Michael K Gupta
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Canada
| | - Ana-Maria Misariu
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Canada
| | - Nadim Saydy
- Division of Otolaryngology-Head and Neck Surgery, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery and Western University, London, Canada
| | - Francisco Laxague
- Department of Head and Neck Surgery, Hospital Aleman of Buenos Aires, Buenos Aires, Argentina
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Huaqi Li
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Natalie Weisbrod
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jesse D Pasternak
- Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Bahar Golbon
- Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Elaine Jin
- Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | | | - Maryse Brassard
- Division of Endocrinology, Department of Medicine, Université Laval, Quebec City, Canada
| | - Florence Lévesque
- Division of Endocrinology, Department of Medicine, Université Laval, Quebec City, Canada
| | - Nader Sadeghi
- Department of Otolaryngology, Head and Neck Surgery, McGill University Health Centre, Montreal, Canada
| | - Thavakumar Subramaniam
- Department of Otolaryngology, Head and Neck Surgery, McGill University Health Centre, Montreal, Canada
| | - Aleksander M Mlynarek
- Department of Otolaryngology Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Canada
| | - Gregoire Bernard Morand
- Department of Otolaryngology Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Canada
- Department of Otolaryngology, University of Zurich, Zurich, Switzerland
| | - Pierre H Fortier
- Department of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Universite Sherbrooke, Sherbrooke, Canada
| | - Laurent Fradet
- Department of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Universite Sherbrooke, Sherbrooke, Canada
| | - Sana Ghaznavi
- Divisions of Endocrinology and University of Calgary, Calgary, Canada
| | | | - Eitan Prisman
- Division of Otolaryngology, University of British Columbia, Vancouver, Canada
| | - Tareck Ayad
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada
| | - Apostolos Christopoulos
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada
| | - Joel C Davies
- Department of Otolaryngology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Murali Rajaraman
- Department of Radiation Oncology and Dalhousie University, Halifax, Canada
| | - Martin Corsten
- Division of Otolaryngology, Dalhousie University, Halifax, Canada
| | - Kye Rajaraman
- Faculty of Medicine, Saint Mary's University, Halifax, Canada
| | - Anastasios Maniakas
- Division of Otolaryngology-Head and Neck Surgery, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Canada
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Mayo-Yáñez M, Palacios-García JM, Calvo-Henríquez C, Ayad T, Saydy N, León X, Parente P, Chiesa-Estomba CM, Lechien JR. COVID-19 Pandemic and its Impact on the Management of Head and Neck Cancer in the Spanish Healthcare System. Int Arch Otorhinolaryngol 2021; 25:e610-e615. [PMID: 34777593 PMCID: PMC8580159 DOI: 10.1055/s-0041-1736425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/04/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has represented a major challenge for healthcare systems worldwide, changing the habits of physicians. A reorganization of healthcare activity has been necessary, limiting surgical activity to essential cases (emergencies and oncology), and improving the distribution of health resources.
Objective
To analyze the impact of the COVID-19 pandemic on head and neck cancer surgery management in Spain.
Methods
A cross-sectional study, through an anonymous and voluntary online survey distributed to 76 Spanish otorhinolaryngology departments.
Results
A total of 44 centers completed the survey, 65.9% of which were high-volume. A total of 45.5% of them had to stop high-priority surgery and 54.5% of head and neck surgeons were relocated outside their scope of practice. Surgeons reported not feeling safe during their usual practice, with a decrease to a 25% of airway procedures. A total of 29.5% were “forced” to deviate from the “standard of care” due to the epidemiological situation.
Conclusions
Approximately half of the departments decreased their activity, not treating their patients on a regular basis, and surgeons were reassigned to other tasks. It seems necessary that the head and neck surgeons balance infection risk with patient care. The consequences of the reported delays and changes in daily practice should be evaluated in the future in order to understand the real impact of the pandemic on the survival of head and neck cancer patients.
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Affiliation(s)
- Miguel Mayo-Yáñez
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.,Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain.,Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain
| | - José M Palacios-García
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.,Otorhinolaryngology - Head and Neck Surgery Department, Hospital Universitario Virgen Macarena (HUVM), Sevilla, Andalucía, Spain
| | - Christian Calvo-Henríquez
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.,Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain.,Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario Santiago de Compostela (CHUS), Santiago de Compostela, Galicia, Spain
| | - Tareck Ayad
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Nadim Saydy
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Xavier León
- Otorhinolaryngology - Head and Neck Surgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España
| | - Pablo Parente
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain
| | - Carlos Miguel Chiesa-Estomba
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.,Otorhinolaryngology - Head and Neck Surgery Department, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - Jérôme R Lechien
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.,Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain.,Human Anatomy & Experimental Oncology Department, Faculty of Medicine UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
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Saydy N, Moubayed SP, Bussières M, Janjua A, Kilty S, Lavigne F, Monteiro E, Nayan S, Piché M, Smith K, Sommer D, Sowerby L, Tewfik MA, Witterick IJ, Wright E, Desrosiers M. What is the optimal outcome after endoscopic sinus surgery in the treatment of chronic rhinosinusitis? A consultation of Canadian experts. J Otolaryngol Head Neck Surg 2021; 50:36. [PMID: 34134762 PMCID: PMC8210358 DOI: 10.1186/s40463-021-00519-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/14/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Many experts feel that in the absence of well-defined goals for success, they have an easier time identifying failure. As success ought to not be defined only by absence of failure, we aimed to define optimal outcomes for endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) by obtaining expert surgeon perspectives. METHODS A total of 12 surgeons participated in this targeted consultation. Face to face semi-structured interviews were performed with expert surgeons in the field of CRS and ESS. General impressions and personal definitions of acceptable operative success and optimal operative outcomes were compiled and summarized. RESULTS According to an expert survey, patients' main objectives are an improvement in their chief complain, a general improvement in quality of life (QoL), and a better overall symptomatic control. The most important aspects of endoscopy for defining a successful intervention were an adequate mucus circulation, a healthy mucosa, minimal edema, and patency of all explored cavities or ostia. In the assessment of surgical outcomes, it was determined that both objective and patient reported data must be carefully examined, with more attention given to subjective outcomes. CONCLUSIONS According to data gathered from a Canadian expert consultation, a definition of success must be based on both subjective data and nasal endoscopy. We propose to define an acceptable outcome as either a subjective improvement of at least the minimal clinically improvement difference of a validated patient reported outcome questionnaire, along with a satisfactory endoscopic result (1) or a complete subjective resolution with a sub-optimal endoscopy (2).
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Affiliation(s)
- Nadim Saydy
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Sami P Moubayed
- Division of Otolaryngology - Head & Neck Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Marie Bussières
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Sherbrooke - Hôtel-Dieu Hospital, University of Sherbrooke, Quebec, Canada
| | - Arif Janjua
- Division of Otolaryngology - Head & Neck Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shaun Kilty
- Division of Otolaryngology - Head & Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - François Lavigne
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Eric Monteiro
- Division of Otolaryngology - Head & Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Smriti Nayan
- Division of Otolaryngology - Head & Neck Surgery, Cambridge Memorial Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Marilou Piché
- Division of Otolaryngology - Head & Neck Surgery, Hôpital Saint-Sacrement, Laval University, Quebec, Quebec, Canada
| | - Kristine Smith
- Division of Otolaryngology - Head & Neck Surgery, Winnipeg Health Sciences Center, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Doron Sommer
- Division of Otolaryngology - Head & Neck Surgery, Cambridge Memorial Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Leigh Sowerby
- Division of Otolaryngology - Head & Neck Surgery, St-Joseph's Hospital, Western University, London, Ontario, Canada
| | - Marc A Tewfik
- Division of Otolaryngology - Head & Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Ian J Witterick
- Division of Otolaryngology - Head & Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Erin Wright
- Division of Otolaryngology - Head & Neck Surgery, Walter C MacKenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, Canada
| | - Martin Desrosiers
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada.
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4
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Saydy N, Moubayed SP, Desrosiers M. Patient perspectives on endoscopic sinus surgery for chronic rhinosinusitis. J Otolaryngol Head Neck Surg 2021; 50:34. [PMID: 34130732 PMCID: PMC8207753 DOI: 10.1186/s40463-021-00515-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/10/2021] [Indexed: 12/22/2022] Open
Abstract
Background Through shared decision-making, physicians and patients can elect endoscopic sinus surgery (ESS) when maximal medical therapy fails in patients with chronic rhinosinusitis (CRS). In this study, we aim to explore the most important themes with regards to patients’ perspectives on ESS. Our objective was to define the patient experience and ensure that we have congruent physician and patient goals for obtaining success. Methods Semi-structured face-to-face interviews were conducted with 22 patients at a tertiary-care institution in Montreal. Three themes were established a priori: living with CRS, objectives and expectations and criteria for success. This thematic approach allowed the identification, analysis and reporting of patterns found across the data set. A phenomenological methodological orientation was used. Interviews were audio-recorded and transcribed verbatim for continuous analysis. These were coded by hand by a single coder who read the transcripts multiple times and relistened to the recordings. Results Exploration of themes on patients’ perspectives on ESS for CRS yielded multiple anecdotal findings, and some recurring patterns. There is a tendency for patients to focus on one principal symptom that drives their decrease in QoL. Headaches and nasal congestion seemed to impact patients’ QoL the most amongst rhinologic symptoms. Hyposmia was rarely spontaneously by patients but was often a significant source of distress when prompted during interviews. Objectives and expectations seemed to be inversely proportional to number of previous surgeries and severity of symptoms preoperatively. There was a clear association between preoperative expectations and postoperative satisfaction. There was no clear pattern in the improvement magnitude or time improved postoperatively for patients to consider the surgery a success. Conclusions Patients’ level of satisfaction postoperatively and with their care in general is multifactorial. We believe the topic of goals and expectations regarding ESS should be discussed preoperatively for every patient with CRS. This includes patients with seemingly minor disease and patients naive to surgery, as can sometimes have exceedingly high expectations. Preoperative counselling must also include an assessment of what symptom is the most cumbersome to that particular patient, as patients tend to focus a lot on one or two symptoms. Postoperatively, we encourage clinicians to be attentive to the change in each patient’s principal complaints within the context of a personalized approach and to refer back to patients’ preoperative goals in their assessment of operative success. Graphical abstract ![]()
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Affiliation(s)
- Nadim Saydy
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, 1051 Sanguinet Street, Montreal, QC, H2X 3E4, Canada
| | - Sami Pierre Moubayed
- Division of Otolaryngology - Head & Neck Surgery, Sacré-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Martin Desrosiers
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, 1051 Sanguinet Street, Montreal, QC, H2X 3E4, Canada.
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5
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Tabet P, Saydy N, Saliba I. Cholesterol Granulomas: A Comparative Meta-Analysis of Endonasal Endoscopic versus Open Approaches to the Petrous Apex. J Int Adv Otol 2020; 15:193-199. [PMID: 31287439 DOI: 10.5152/iao.2019.5859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Petrous apex cholesterol granulomas (PACG) are rare disorders that can lead to patient morbidity and must, occasionally, be drained by either endoscopic endonasal (EN) or open procedures (OP). The objective of our study was to complete a review of the literature to compare the EN and OP approaches on multiple levels, notably on safety and effectiveness. Ovid MEDLINE and Embase were used to perform a thorough literature review of all cases of PACG treated by either EN or OP dating from January 1948 to August 2017. In total, 49 articles were selected including 23 for EN (n=76) and 26 for OP (n=210). Differences were found in the incidence of preoperative hearing loss (HL) (EN 18.4%, OP 57.3%; p<0.001), headache (EN 48.7%, OP 31.2%; p=0.007), and disequilibrium (EN: 14.5%, OP 26.1%; p=0.04). Differences in lesion proximity to the sphenoid sinus (EN 23.6%, OP: 1.0%; p<0.001), clivus (EN 11.8%, OP 4.7%; p=0.03), otic capsule (EN 0.0%, OP 5.2%; p=0.03), internal auditory canal (EN 2.6%, OP 10.9%; p=0.01), and internal carotid artery (ICA) (EN 9.2%, OP 2.8%; p=0.02) were found on preoperative imaging. The EN procedure had better hearing improvement rates (EN 85.7%, OP 23.4%; p<0.001), lower complication rates (EN 7.9%, OP 17.6%; p=0.04), shorter median follow-up (EN:13.5 months, OP:37.2 months; p<0.001), and shorter time to recurrence (EN 3 months, OP 22.6 months; p=0.002) than the known OP. No differences were found in age, preoperative size, recurrence rate, operative time, stent placement, or improvement of other symptoms. Endoscopic nasal approaches, when feasible, should be favored to open procedures for PACG drainage given their better hearing improvement and less complication rates.
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Affiliation(s)
- Paul Tabet
- Division of Otorhinolaryngology Head - Neck Surgery - Otology and Neurotology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Nadim Saydy
- University of Montreal, Montreal, Quebec, Canada
| | - Issam Saliba
- Division of Otorhinolaryngology Head - Neck Surgery - Otology and Neurotology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
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Tabet P, Saydy N, Letourneau-Guillon L, Gologan O, Bissada É, Ayad T, Tabet JC, Guertin L, Nguyen-Tan PF, Christopoulos A. Cystic masses of the lateral neck: Diagnostic value comparison between fine-needle aspiration, core-needle biopsy, and frozen section. Head Neck 2019; 41:2696-2703. [PMID: 30945785 DOI: 10.1002/hed.25755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/09/2019] [Accepted: 03/12/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The usefulness of fine-needle aspiration (FNA), core-needle biopsy (CNB), and frozen section (FS) for assessing lateral cystic neck masses (LCNM) remains unclear. METHODS A retrospective review of patients presenting with a LCNM was undertaken. RESULTS In total, 135 patients were included. FNA had a lower sensitivity then CNB (59% vs 83%; P = .036) and FS (59% vs 93%; P = .01). FS had a better negative predictive value (NPV) when compared to FNA (92% vs 40%; P < .001) and CNB (92% vs 50%; P = .062). Positive predictive values (PPV) and sensitivities were similar among all groups. CONCLUSION Given its adequate PPV (92%), FNA should be used initially on LCNM. Because of its high sensitivity, CNB should be considered if FNA is not diagnostic of malignancy. FS should always follow a CNB indicative of malignancy, because of low NPV. A diagnosis of malignancy on FNA, CNB, or FS strongly indicates presence of malignancy.
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Affiliation(s)
- Paul Tabet
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Nadim Saydy
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Laurent Letourneau-Guillon
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Olga Gologan
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Éric Bissada
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Tareck Ayad
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Jean-Claude Tabet
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Louis Guertin
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Phuc Félix Nguyen-Tan
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Apostolos Christopoulos
- Division of Otolaryngology - Head & Neck Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
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7
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Mazine A, Bouhout I, Saydy N, Stevens LM, Gagné-Loranger M, Eynden FV, Parent D, Lamarche Y, Bouchard D. Relative Adrenal Insufficiency Is Associated With Prolonged Postoperative Hemodynamic Instability. Ann Thorac Surg 2018; 106:702-707. [PMID: 29750931 DOI: 10.1016/j.athoracsur.2018.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/14/2018] [Accepted: 04/04/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND We assessed the hypothesis that a significant proportion of patients undergoing cardiac surgery have postoperative relative adrenal insufficiency (RAI), and that this puts them at higher risk of persistent hemodynamic instability. METHODS A prospective study included 135 patients who underwent cardiac surgery using cardiopulmonary bypass between July 2006 and December 2007. Adrenal function was assessed 36 hours after surgery using a 1-μg cosyntropin (adrenocorticotropic hormone [ACTH]) stimulation test. Relative adrenal insufficiency was defined as a peak cortisol level inferior to 500 nmol/L or an increase in cortisol of less than 250 nmol/L, or both, compared with baseline. The primary endpoint was hemodynamic instability at 48 hours after surgery, defined as persistent requirement for any vasoactive drug. The secondary endpoint was long-term survival. RESULTS Postoperative RAI was diagnosed in 75 patients (56%). Compared with patients who showed a normal response to the ACTH stimulation test, patients with RAI had significantly higher rates of hemodynamic instability at 48 hours (40% versus 22%, p = 0.03). On multivariable analysis, adrenal response to the ACTH test was a significant independent predictor of hemodynamic instability at 48 hours after surgery (odds ratio 1.06 [95% confidence interval: 1.02 to 1.11] per 10 nmol/L cortisol decrease; p = 0.002). At a mean follow-up of 8.3 ± 2.8 years, patients without perioperative RAI had survival equivalent to that of the general population, whereas patients with RAI had lower than expected survival. CONCLUSIONS Postoperative RAI is common among patients undergoing cardiac surgery and is associated with an increased risk of persistent hemodynamic instability.
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Affiliation(s)
- Amine Mazine
- Division of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Ismail Bouhout
- Division of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Nadim Saydy
- Division of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Louis-Mathieu Stevens
- Division of Cardiac Surgery, Centre Hospitalier Universitaire de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Maude Gagné-Loranger
- Division of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Frédéric Vanden Eynden
- Division of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Daniel Parent
- Division of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Yoan Lamarche
- Division of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Denis Bouchard
- Division of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
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Mazine A, Bouhout I, Saydy N, Stevens L, Gagné-Loranger M, Lamarche Y, Bouchard D. RELATIVE ADRENAL INSUFFICIENCY IS ASSOCIATED WITH PROLONGED POSTOPERATIVE HEMODYNAMIC INSTABILITY IN PATIENTS UNDERGOING CARDIAC SURGERY. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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