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The Laryngoscope © 2023 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.
Postoperative Care of Zenker Diverticula: Contemporary Perspective from the Prospective OUtcomes Cricopharyngeaus Hypertonicity (POUCH) Collaborative Mallory McKeon, MD ; Nicole McCoy, BS; Christopher Johnson, MD ; Jacqui Allen, MD ; Mekibib Altaye, PhD; Milan Amin, MD; Semirra Bayan, MD; Peter Belafsky, MD ; Brad DeSilva, MD ; Greg Dion, MD ; Dale Ekbom, MD ; Aaron Friedman, MD ; Mark Fritz, MD ; John Paul Giliberto, MD ; Elizabeth Guardiani, MD; Jan Kasperbauer, MD ; Brandon Kim, MD; Brittany N. Krekeler, PhD ; Maggie Kuhn, MD ; Paul Kwak, MD; Yue Ma, MD ; Lyndsay L. Madden, MD; Laura Matrka, MD ; Ross Mayerhoff, MD ; Cyrus Piraka, MD; Clark A. Rosen, MD ; Meredith Tabangin, MPH ; Shaun Wahab, MD; Keith Wilson, MD; Carter Wright, MD; VyVy N. Young, MD ; Gregory Postma, MD; Rebecca J. Howell, MD Objectives: The aim of the study was to identify trends in postoperative management of persons undergoing surgery for Zenker diverticula (ZD) by evaluating length of stay (LOS), diet on discharge, and imaging with or without surgical complication. Methods: Prospectively enrolled adult patients with cricopharyngeal muscle dysfunction with diverticula undergoing sur gery from August 1, 2017 to February 1, 2023 were included. Data were extracted from a multi-institutional REDCap database, summarizing means, medians, percentages, and frequencies. Fisher ’ s exact or chi squared analyses were utilized, as appropri ate, to compare subsets of data. Descriptive analysis assessed differences in clinical course and the relationship to postopera tive management. Results: There were 298 patients with a mean (standard deviation) age of 71.8 (11.2) years and 60% male. Endoscopic surgery was performed in 79.5% (237/298) of patients versus 20.5% (61/298) open surgery. Sixty patients (20.1%) received postoperative imaging, with four leaks identi fi ed. Complications were identi fi ed in 9.4% of cases ( n = 29 complications in 28 patients), more commonly in open surgery. Most (81.2%) patients were discharged within 23 h. About half of patients (49%) were discharged from the hospital on a pureed/liquid diet; 36% had been advanced to a soft diet. In patients without complications, LOS was signi fi cantly longer following open cases ( p = 0.002); postoperative diet was not different between open and endoscopic ( p = 0.26). Conclusions: Overall, most patients are discharged within 23 h without imaging. However, LOS was affected by surgical approach. Postoperative complications are different in endoscopic versus open surgery. Complications with either approach were associated with prolonged LOS, need for imaging, and diet restriction.
Sciences and Disorders, College of Allied Health Sciences ( B . N . K .), University of Cincinnati, Cincinnati, Ohio, U.S.A.; Department of Otolaryngology-Head and Neck Surgery ( Y . M ., C . A . R ., V . N . Y .), University of California – San Francisco, San Francisco, California, U.S.A.; Department of Otolaryngology-Head and Neck Surgery ( L . L . M ., C . W .), Wake Forest University, Winston-Salem, North Carolina, U.S.A.; Department of Otolaryngology-Head and Neck Surgery ( R . M .), Henry Ford Health System, Detroit, Michigan, U.S.A.; Department of Gastroenterology/ Hepatology ( C . P .), Henry Ford Health System, Detroit, Michigan, U.S.A.; and the Department of Radiology ( S . W .), University of Cincinnati, Cincinnati, Ohio, U.S.A. Additional supporting information may be found in the online version of this article. Editor ’ s Note: This Manuscript was accepted for publication on November 27, 2023. Presented at the 103rd Annual Meeting of the American Broncho Esophagological Association within the Combined Otolaryngology Society Meetings, Boston, MA, May 3 – 7, 2023. Supported by the Triological Society 2019 Research Career Develop ment Award. The authors have no other funding, fi nancial relationships, or con fl icts of interest to disclose. Send correspondence to Rebecca J. Howell, MD, Division of Laryn gology, Department of Otolaryngology Head and Neck Surgery, University of Cincinnati, Cincinnati, OH. Email: howellrb@ucmail.uc.edu
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is prop erly cited, the use is non-commercial and no modi fi cations or adaptations aremade. From the Department of Otolaryngology-Head and Neck Surgery ( M . M ., N . M ., G . D ., A . F ., B . N . K ., K . W ., R . J . H .), University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.; Department of Otolaryngology-Head and Neck Surgery ( C . J ., G . P .), Medical College of Georgia at Augusta University Health, Augusta, Georgia, U.S.A.; Department of Surgery ( J . A .), University of Auckland, Auckland, New Zealand; Division of Biostatistics and Epidemiology ( M . A ., M . T .), Cincinnati Children ’ s Hospital Medical Center, Cincinnati, Ohio, U.S.A.; Department of Otolaryngology Head and Neck Surgery ( M . A ., P . K .), New York University, New York, New York, U.S.A.; Department of Otolaryngology-Head and Neck Surgery ( S . B ., D . E ., J . K .), Mayo Clinic, Rochester, Minnesota, U.S.A.; Department of Otolaryngology-Head and Neck Surgery ( P . B ., M . K .), University of California – Davis, Davis, California, U.S.A.; Department of Otolaryngology-Head and Neck Surgery ( B . D ., B . K ., L . M .), Ohio State University, Columbus, Ohio, U.S.A.; Department of Otolaryngology-Head and Neck Surgery ( M . F .), University of Kentucky, Lexington, Kentucky, U. S.A.; Department of Otolaryngology-Head and Neck Surgery ( J . P . G .), University of Washington, Seattle, Washington, U.S.A.; Department of Otolaryngology-Head and Neck Surgery ( E . G .), University of Maryland, Baltimore, Maryland, U.S.A.; Department of Neurology and Rehabilitation Medicine ( B . N . K .), University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.; Department of Communication
DOI: 10.1002/lary.31226
Laryngoscope 134: June 2024
McKeon et al.: Postop Management of ZD, Contemp. Perspective
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