2017-18 HSC Section 3 Green Book

TABLE II. Characteristics of Epistaxis Patients Receiving Ligation Versus Embolization

Patient Characteristics

N

Ligation

Embolization

P Value

Age (years), mean 1 SD

64.1 6 16.5

62.4 6 15.6

1,811

0.027*

Race (%)

1,523

0.253

White

76.2

74.6

Black

12.5

10.1

Hispanic

6.2 2.5

8.3 3.1

Asian/Pacific Islander

Other

2.6

3.9

Gender (%)

1,809

0.003*

Male

55.6

62.5

Female

44.4

37.5

Nonelective admission (%)

1,808 1,813

6.3

11.2

< 0.001*

Length of stay (days), mean 6 SD Hospital charges (dollars), mean 6 SD

3.6 6 3.7

4.0 6 4.2

0.014*

33,030 6 39,240

69,304 6 59,938

1,779

< 0.001*

*Significant at P < 0.05. SD 5 standard deviation.

serious comorbidities. 4,7,8 We therefore expected that the embolization group would have a higher mean age and higher rates of comorbidities. Counter to what we expected, the ligation group was about 2 years older than the embolization group, and none of the comorbid- ities that we analyzed were significantly more common in the embolization cohort. In fact, congestive heart fail- ure was more common among patients receiving ligation. The average hospitalization cost for epistaxis has recently been reported as $6,925 per person. 2 The weighted average total cost of treating epistaxis was also estimated to be over $106 million annually. 2 In an era of rising healthcare costs, literature has appropriate- ly focused on the cost of various treatment modalities for refractory epistaxis. 2,4,9 It has been well documented that endovascular embolization results in greater hospi- tal charges than arterial ligation. 3–5,10 Results from the present study are consistent with this finding; embolized

epistaxis patients incurred double the amount of total hospital charges compared to ligation patients. Although the embolization group had longer lengths of stay and a higher rate of airway complications resulting in intuba- tion/tracheostomy, these findings alone likely do not fully explain the large disparity in charges. Arterial embolization is typically thought to carry a greater risk of serious complications compared to arteri- al ligation due to proximal endovascular manipulation of the carotid artery branches. These complications include cerebrovascular accident, hemiplegia, ophthalmoplegia, facial nerve palsy, and seizure. 3–5,8,10–16 Despite these previous reports, no difference was found between the ligation and embolization groups with respect to rate of stroke or blindness. Overall in-hospital mortality also was not found to be significantly different between the two groups, suggesting similar overall safety profiles for the two modalities. However, the rate of airway inter- vention via intubation/tracheostomy was greater in the embolization group, suggesting that arterial emboliza- tion treatment of refractory epistaxis may be associated with increased risk of airway compromise. In summary, treatment of epistaxis via surgical ligation is associated with decreased morbidity but similar mortality com- pared to endovascular arterial embolization.

TABLE III. Comorbidity Frequencies in Patients Receiving Ligation Versus Embolization (N 5 1,813)

Ligation (%)

Embolization (%)

Comorbidities

P Value

Diabetes mellitus

22.2

19.7

0.187 1.000

TABLE IV. In-Hospital Complications in Patients Receiving Ligation Versus Embolization (N 5 1,813)

Hereditary hemorrhagic telangiectasia

0.4

0.4

Congestive heart failure

15.1

9.8

0.001*

Complications

Ligation (%)

Embolization (%)

P Value

Chronic pulmonary disease

23.5

19.8

0.060 0.501

Coagulopathy

8.6

9.5

Stroke

0.3

0.5

0.471

Hypertension

67.6

67.2

0.854

Blindness

0.5

0.4

1.000

Liver disease

3.2 8.3

2.6 6.9

0.440 0.280

Transfusion

24.3

22.8

0.435

Obesity

Intubation/tracheostomy

2.8

5.3

0.009*

Peripheral vascular disorders

5.7

6.8

0.330

In-hospital mortality

1.1

0.6

0.450

*Significant at P < 0.05.

*Significant at P < 0.05.

Laryngoscope 127: May 2017

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