Chantal Holy

Efficacy of mesenchymal stem cell enriched grafts in an ovine posterolateral lumbar spine model.

Study Design. Four groups of 6 animals underwent single-level noninstrumented posterolateral lumbar fusion (PLF) with one of the following grafts: 1) autograft, 2) cell-enriched &bgr;-tricalcium phosphate (TCP), 3) TCP with whole bone marrow, and 4) TCP alone. Plain radiographs were taken after surgery and at death, 6 months after surgery. Explanted spine segments were analyzed by manual palpation, micro-CT, and histology. Objective. A sheep spine fusion study was undertaken to evaluate the healing performance of a TCP graft enriched with osteoprogenitor cells using Selective Cell Retention technology (SCR), compared with autograft, TCP with whole bone marrow, and TCP alone. Summary of Background Data. Improved bone healing with previously demonstrated using grafts enriched in osteoprogenitor cells. Methods. Cell-enriched grafts were obtained by processing 30 mL of bone marrow through 10 mL of TCP. TCP was also used either saturated with bone marrow or alone. Results. At 6 months, 33% of the SCR-enriched TCP and 25% of the autograft sites were fused, compared with 8% of the TCP plus whole bone marrow and 0% of the TCP alone. Histology of fused samples showed denser bone formation in the SCR-enriched TCP grafts than in the autograft sites. Conclusions. The use of SCR-enriched TCP and autograft resulted in similar fusion rates in an ovine posterolateral noninstrumented lumbar spine fusion model.

Early versus Delayed Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis: Impact on Health Care Utilization

Objective To evaluate the impact of early versus delayed endoscopic sinus surgery (ESS) in terms of postoperative health care utilization, using a patient cohort with chronic rhinosinusitis (CRS). Study Design Retrospective administrative database analysis. Setting US-based primary and secondary sites of care. Subjects and Methods CRS patients with ESS in 2010—with no other ESS before 2010 and with complete medical history from 2004 to 2012—were identified within the MarketScan database. Patients were characterized by time interval of first sinusitis or nasal polyposis diagnosis to ESS and grouped as following: group 1, < 1 year (n = 818); group 2, 1 to <2 years (n = 247); group 3, 2 to <3 years (n = 274); group 4, 3 to <4 years (n = 364); group 5, 4 to <5 years (n = 595); and group 6, ≥5 years (n = 535). Outpatient visits/procedures and prescriptions associated with sinusitis and/or nasal polyps were analyzed for 1 year preoperatively and 2 years postoperatively. Subanalyses were conducted on separate cohorts with or without asthma or polyps, within each group. Results Patients in group 1 had significantly fewer visits and prescriptions than patients in group 6 (postoperative visits: group 1, 4.45 [95% CI, 4.06-4.84]; group 6, 6.70 [95% CI, 6.10-7.30; prescriptions: group 1, 4.54 [95% CI, 4.12-4.96]; group 6, 7.61 [95% CI, 6.92-8.31]). Gradual increases in utilization were observed from groups 1 to 6. Subanalysis of patients with and without asthma or polyps showed similar findings. Conclusion Early intervention after diagnoses of CRS, with or without asthma or polyps, is associated with lower health care utilization than intervention after many years of medical management.

The Impact of Endoscopic Sinus Surgery on Health Care Use in Patients with Respiratory Comorbidities

Objective Analyze health care needs and outcomes—defined by changes in health care utilization—in cohorts of patients with respiratory comorbidities and requiring sinus surgery for the treatment of chronic rhinosinusitis (CRS). Study Design Retrospective database analysis. Setting US-wide claims database (MarketScan). Subjects and Methods All patients with endoscopic sinus surgery (CPT 31254-31288) in 2008 and at least 2 years of continuous enrollment prior and post surgery were analyzed for concurrent comorbidities (asthma, polyps, aspirin sensitivity, and allergies). Inpatient and outpatient events as well as prescriptions related to the treatment of CRS were analyzed for frequency and cost, based on respiratory comorbidities. Results A total of 9105 patients were included and subdivided as following: no respiratory comorbidity (N = 4780), asthma only (N = 1167), polyps and asthma (N = 721), Samter’s triad (N = 91), and additional subgroups based on various combinations of concurrent comorbidities. Before surgery, costs were flat, ranging from

Endoscopic Sinus Surgery Provides Effective Relief as Observed by Health Care Use Pre- and Postoperatively

296.4 (95% CI,

The impact of balloon catheter dilation on frequency of sinus surgery in the United States

263.1-

Prevalence and Occupation of Patients Presenting With Dysphonia in the United States

329.8) per patient per year for patients in the no comorbidity group to

Prevalence of atopic disease in patients with eosinophilic esophagitis

2189 (95% CI,

Impact of medically recalcitrant chronic rhinosinusitis on incidence of asthma

1449.2-

Why the Confusion About Sinus Headache

2930.1) for patients with Samter’s triad. Surgery was preceded by at least 6 months of increased health care utilization (outpatient care and prescriptions). Following surgery, health care needs declined rapidly and reached baseline levels within 3 to 4 postoperative months. Patients with asthma received significantly more health care for CRS than patients without asthma through the entire study. Conclusions Patients with CRS incur continuous costs and health care needs, due to the chronic nature of their disease. All patients, regardless of comorbidity, experienced significant decline in health care needs following sinus surgery from their preoperative state.

Variation in Delivery of Sinus Surgery in the Medicaid Population across Ethnicities

Objective To analyze the impact of endoscopic sinus surgery (ESS) on overall health care utilization for the treatment of chronic rhinosinusitis (CRS). Study Design Retrospective administrative database analysis. Setting All US-based primary and secondary sites of care. Subjects and Methods A cohort of patients with ESS (Current Procedural Terminology codes 31254-31288) in 2008 and at least 5 years of continuous medical and drug plan enrollment were included (n = 9105). Inpatient and outpatient medical history (including prescriptions) was analyzed from weeks −104 to +104 postoperatively. Results Health care utilization was constant up to −6 months preoperatively, at a per-patient per-week (PPPW) average of