Document Type : review article

Authors

1 BA, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

2 MD, Department of Otolaryngology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

3 PhD, Department of Otolaryngology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

4 PhD, Department of Otolaryngology, Arkansas Children’s Hospital, Little Rock, AR, USA.

5 MD, Department of Otolaryngology, Arkansas Children’s Hospital, Little Rock, AR, USA.

10.22038/jpp.2024.77273.5444

Abstract

Background: We aimed to investigate the length of hospital stay for resection of juvenile nasopharyngeal angiofibroma (JNA) as it relates to preoperative embolization status.
Methods: Pediatric males (0-18 years old) with the diagnosis of a benign neoplasm of the nasopharynx who underwent surgical resection between 2004 and 2022 were included in this retrospective cohort study. Patients were then separated into two groups based on their preoperative embolization status. Length of stay between the two groups and intercenter variation in length stay was investigated.
Results: 706 patients, with a mean age of 14 years, were analyzed. 114 patients received embolization prior to surgical resection while 592 patients did not receive preoperative embolization. The age of admission, gestational age, and ethnicity were consistent between the two groups. The length of stay for the group that received preoperative embolization was 3 days, while the length of stay for the no embolization group was 2 days. In addition, nine centers were identified as having significantly higher inter-center variation in LOS.
Conclusions: Embolization prior to removal of JNA increases the length of stay, despite having similar rates of transfusion. While the difference in length of stay can likely be explained by the fact that patients get admitted a day prior to surgery for embolization, it is unclear why there is significant inter-center variation.

Keywords

  1. Overdevest JB, Amans MR, Zaki P, Pletcher SD, El‐Sayed IH. Patterns of vascularization and surgical morbidity in juvenile nasopharyngeal angiofibroma: a case series, systematic review, and meta‐analysis. Head & neck. 2018 Feb;40(2):428-43.
  2. Pool C, Gates CJ, Patel VA, Carr MM. Juvenile nasopharyngeal angiofibroma: national practice patterns and resource utilization via HCUP KID. International Journal of Pediatric Otorhinolaryngology. 2021 Oct 1;149:110871.
  3. Boghani Z, Husain Q, Kanumuri VV, Khan MN, Sangvhi S, Liu JK, et al. Juvenile nasopharyngeal angiofibroma: a systematic review and comparison of endoscopic, endoscopic‐assisted, and open resection in 1047 cases. The Laryngoscope. 2013 Apr;123(4):859-69.
  4. Roger G, Huy PT, Froehlich P, Van Den Abbeele T, Klossek JM, Serrano E, et al. Exclusively endoscopic removal of juvenile nasopharyngeal angiofibroma: trends and limits. Archives of Otolaryngology–Head & Neck Surgery. 2002 Aug 1;128(8):928-35.
  5. Lutz J, Holtmannspötter M, Flatz W, Meier-Bender A, Berghaus A, Brückmann H, et al. Preoperative embolization to improve the surgical management and outcome of juvenile nasopharyngeal angiofibroma (JNA) in a single center: 10-year experience. Clinical neuroradiology. 2016 Dec;26:405-13.
  6. Moulin G, Chagnaud C, Gras R, Gueguen E, Dessi P, Gaubert JY, et al. Juvenile nasopharyngeal angiofibroma: comparison of blood loss during removal in embolized group versus nonembolized group. Cardiovascular and interventional radiology. 1995 May;18:158-61.
  7. Tranbahuy P, Borsik M, Herman P, Wassef M, Casasco A. Direct intratumoral embolization of juvenile angiofibroma. American journal of otolaryngology. 1994 Nov 1;15(6):429-35.
  8. Glad H, Vainer B, Buchwald C, Petersen BL, Theilgaard SA, Bonvin P, et al. Juvenile nasopharyngeal angiofibromas in Denmark 1981–2003: diagnosis, incidence, and treatment. Acta oto-laryngologica. 2007 Jan 1;127(3):292-9.
  9. Akbas Y, Anadolu Y. Extranasopharyngeal angiofibroma of the head and neck in women. American journal of otolaryngology. 2003 Nov 1;24(6):413-6.