Dr. Graboyes said that figuring out how to lower readmission rates might be more of a challenge than assessing the risk factors. “In the readmission literature, this is often where things stop,” he said. “There are certain things that are not modifiable.” But while physicians and hospitals might not be able to alter factors such as co-morbidities and discharge to a nursing facility, they can change other factors associated with those risks, he said.
Explore This IssueApril 2016
Hospitals, he recommended, can emphasize thorough prep and assessment of patients and their co-morbidities, so that procedures can be optimized for their needs. He also stressed coordination of post-discharge care, “whether that’s familiarizing them with otolaryngology wound care, instituting closer follow-up, triaging appropriate people, [or] making sure they have appropriate social support structure—all of those are important.”
Platelet-Rich Plasma and Platelet-Rich Fibrin in Otolaryngology
Researchers at the University of Toronto in Ontario, Canada, tried to determine why autologous platelet concentrates (APP) are not used more widely to promote healing after otolaryngology procedures, even though they have been found to be safe, they’re minimally invasive, and, in many settings, they’re not very expensive.
The products are concentrates of human platelets drawn from a patient’s blood in the operating room and re-injected locally, said Yael Bensoussan, MD, a resident at the University of Toronto who presented the findings. The principle is that concentrating platelets concentrates growth factors and adhesion molecules as well, causing a cascade of activity involved in the healing process.
The concentrates come in two forms: platelet-rich plasma (PRP), which requires two centrifugations to get the needed platelet concentration, and platelet-rich fibrin (PRF), which requires just one. Ready-to-use kits are available for $200 to $2,000, but if you already have a centrifuge, it costs very little, Dr. Bensoussan said. “Basically, if you have a centrifuge at your hospital setting, then the only costs are about $5 U.S. for the material to draw the blood and re-inject the product,” she said.
The researchers conducted anonymous surveys to assess the use of APP in otolaryngology compared with oral and maxillofacial surgery, where it is more commonly used. They surveyed members of the Canadian Society of Otolaryngology-Head and Neck Surgery (COHNS) and the Canadian Association of Oral and Maxillofacial Surgeons (COMFS) and found that 84% of COHNS respondents had heard of APP, and 14% were using it, while 99% of COMFS respondents had heard of it, and 30% were using it. The top reason given by members of COHNS for not using APP was a lack of knowledge about the product, followed by cost, a perceived lack of evidence in the literature, and lack of need. Among COMFS responders, a lack of evidence was the top reason given for not using APP, followed by cost and lack of need.