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J Neurol Surg B Skull Base 2022; 83(01): 076-081
DOI: 10.1055/s-0040-1716676
Original Article

Effects of Preoperative Embolization on Juvenile Nasopharyngeal Angiofibroma Surgical Outcomes: A Study of the Kids' Inpatient Database

Jonathan S. Choi 
1   Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
,
Justin Yu
1   Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
,
Benjamin D. Lovin
1   Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
,
Alyssa C. Chapel
1   Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
,
Akash J. Patel
1   Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
2   Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
,
K. Kelly Gallagher
1   Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
2   Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
› Author Affiliations Funding None.
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Abstract

Objectives The aim of the study is to evaluate the effect of preoperative vascular embolization (PVE) on juvenile nasopharyngeal angiofibroma (JNA) surgical outcomes using a national pediatric hospitalization database.

Methods The health care cost and utilization project Kids' Inpatient Database was queried for all cases of operative management of JNA between the years of 1997 and 2016. Cases were stratified based on whether the patient received PVE. A multiple linear regression was used to predict the effect of PVE on hospital length of stay (LOS) and total cost while controlling for patient demographic factors and comorbidities. The odds ratio (OR) of receiving a perioperative blood transfusion was computed using a binary logistic regression for PVE patients.

Results A total of 473 patients who underwent JNA surgical resection in this time period were identified. The use of PVE has increased from 0% in 1997 to 66% of all cases by 2016. PVE was found to decrease LOS by 1 day (p = 0.036) and decrease the odds of needing a perioperative blood transfusion (OR = 0.511, p = 0.041). Patients receiving PVE were charged an additional $35,600 (p < 0.001), but recent data in 2016 indicate that hospital costs for PVE are decreasing.

Conclusion PVE of JNA is becoming increasingly prevalent. Embolization results in decreased hospital LOS and lower odds of needing blood transfusions. While embolization increases the cost of management, this trend should be re-evaluated as this procedure is becoming more widespread.

Keywords

JNA - embolization - length of stay - preoperative vascular embolization - health care cost


Publication History

Received: 02 April 2020

Accepted: 25 July 2020

Article published online:
12 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Gullane PJ, Davidson J, O'Dwyer T, Forte V. Juvenile angiofibroma: a review of the literature and a case series report. Laryngoscope 1992; 102 (08) 928-933
    CrossrefPubMedGoogle Scholar
  • 2 Sivanandan R, Willard E. Benign and malignant tumors of the nasopharynx. In: Cummings C, Haughey B, Thomas J, Harker L. eds. Cummings Otolaryngology: Head and Neck Surgery. 4th ed. Philadelphia, PA: Elsevier, Mosby; 2005: 1669-1684
    Google Scholar
  • 3 López F, Triantafyllou A, Snyderman CH. et al. Nasal juvenile angiofibroma: current perspectives with emphasis on management. Head Neck 2017; 39 (05) 1033-1045
    CrossrefPubMedGoogle Scholar
  • 4 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; 40 (02) 428-443
    CrossrefPubMedGoogle Scholar
  • 5 Natvig K, Skalpe IO. Pre-operative embolization of juvenile nasopharyngeal angiofibromas with gel foam. J Laryngol Otol 1984; 98 (08) 829-833
    CrossrefPubMedGoogle Scholar
  • 6 Roberson GH, Price AC, Davis JM, Gulati A. Therapeutic embolization of juvenile angiofibroma. AJR Am J Roentgenol 1979; 133 (04) 657-663
    CrossrefPubMedGoogle Scholar
  • 7 Leong SC. A systematic review of surgical outcomes for advanced juvenile nasopharyngeal angiofibroma with intracranial involvement. Laryngoscope 2013; 123 (05) 1125-1131
    CrossrefPubMedGoogle Scholar
  • 8 Tan G, Ma Z, Long W. et al. Efficacy of preoperative transcatheter arterial embolization for nasopharyngeal angiofibroma: a comparative study. Cardiovasc Intervent Radiol 2017; 40 (06) 836-844
    CrossrefPubMedGoogle Scholar
  • 9 Lutz J, Holtmannspötter M, Flatz W. et al. Preoperative embolization to improve the surgical management and outcome of juvenile nasopharyngeal angiofibroma (JNA) in a single center: 10-year experience. Clin Neuroradiol 2016; 26 (04) 405-413
    CrossrefPubMedGoogle Scholar
  • 10 HCUP-US. KID Overview. Accessed February 18, 2019 at: https://www.hcup-us.ahrq.gov/kidoverview.jsp
    PubMed
  • 11 Antonelli AR, Cappiello J, Di Lorenzo D, Donajo CA, Nicolai P, Orlandini A. Diagnosis, staging, and treatment of juvenile nasopharyngeal angiofibroma (JNA). Laryngoscope 1987; 97 (11) 1319-1325
    CrossrefPubMedGoogle Scholar
  • 12 Lee JT, Chen P, Safa A, Juillard G, Calcaterra TC. The role of radiation in the treatment of advanced juvenile angiofibroma. Laryngoscope 2002; 112 (7 Pt 1): 1213-1220
    CrossrefPubMedGoogle Scholar
  • 13 Reddy KA, Mendenhall WM, Amdur RJ, Stringer SP, Cassisi NJ. Long-term results of radiation therapy for juvenile nasopharyngeal angiofibroma. Am J Otolaryngol 2001; 22 (03) 172-175
    CrossrefPubMedGoogle Scholar
  • 14 Santaolalla F, Araluce I, Zabala A, López A, Garay M, Sanchez JM. Efficacy of selective percutaneous embolization for the treatment of intractable posterior epistaxis and juvenile nasopharyngeal angiofibroma (JNA). Acta Otolaryngol 2009; 129 (12) 1456-1462
    CrossrefPubMedGoogle Scholar
  • 15 Davis KR. Embolization of epistaxis and juvenile nasopharyngeal angiofibromas. AJR Am J Roentgenol 1987; 148 (01) 209-218
    CrossrefPubMedGoogle Scholar
  • 16 Moulin G, Chagnaud C, Gras R. et al. Juvenile nasopharyngeal angiofibroma: comparison of blood loss during removal in embolized group versus nonembolized group. Cardiovasc Intervent Radiol 1995; 18 (03) 158-161
    CrossrefPubMedGoogle Scholar
  • 17 Siniluoto TM, Luotonen JP, Tikkakoski TA, Leinonen AS, Jokinen KE. Value of pre-operative embolization in surgery for nasopharyngeal angiofibroma. J Laryngol Otol 1993; 107 (06) 514-521
    CrossrefPubMedGoogle Scholar
  • 18 Andrade NA, Pinto JA, Nóbrega MdeO, Aguiar JE, Aguiar TF, Vinhaes ES. Exclusively endoscopic surgery for juvenile nasopharyngeal angiofibroma. Otolaryngol Head Neck Surg 2007; 137 (03) 492-496
    CrossrefPubMedGoogle Scholar
  • 19 Lloyd G, Howard D, Phelps P, Cheesman A. Juvenile angiofibroma: the lessons of 20 years of modern imaging. J Laryngol Otol 1999; 113 (02) 127-134
    CrossrefPubMedGoogle Scholar
  • 20 Roger G, Tran Ba Huy P, Froehlich P. et al. Exclusively endoscopic removal of juvenile nasopharyngeal angiofibroma: trends and limits. Arch Otolaryngol Head Neck Surg 2002; 128 (08) 928-935
    CrossrefPubMedGoogle Scholar
  • 21 Wormald PJ, Van Hasselt A. Endoscopic removal of juvenile angiofibromas. Otolaryngol Head Neck Surg 2003; 129 (06) 684-691
    CrossrefPubMedGoogle Scholar
  • 22 Gay I, Elidan J, Gordon R. Oronasal fistula—a possible complication of preoperative embolization in the management of juvenile nasopharyngeal angiofibroma. J Laryngol Otol 1983; 97 (07) 651-656
    CrossrefPubMedGoogle Scholar
  • 23 Casasco A, Houdart E, Biondi A. et al. Major complications of percutaneous embolization of skull-base tumors. AJNR Am J Neuroradiol 1999; 20 (01) 179-181
    PubMedGoogle Scholar
  • 24 Tseng EY, Narducci CA, Willing SJ, Sillers MJ. Angiographic embolization for epistaxis: a review of 114 cases. Laryngoscope 1998; 108 (4 Pt 1): 615-619
    CrossrefPubMedGoogle Scholar
  • 25 Siniluoto TM, Leinonen AS, Karttunen AI, Karjalainen HK, Jokinen KE. Embolization for the treatment of posterior epistaxis. An analysis of 31 cases. Arch Otolaryngol Head Neck Surg 1993; 119 (08) 837-841
    CrossrefPubMedGoogle Scholar
  • 26 Borghei P, Baradaranfar MH, Borghei SH, Sokhandon F. Transnasal endoscopic resection of juvenile nasopharyngeal angiofibroma without preoperative embolization. Ear Nose Throat J 2006; 85 (11) 740-743 , 746
    CrossrefPubMedGoogle Scholar
  • 27 Douglas R, Wormald PJ. Endoscopic surgery for juvenile nasopharyngeal angiofibroma: where are the limits?. Curr Opin Otolaryngol Head Neck Surg 2006; 14 (01) 1-5
    CrossrefPubMedGoogle Scholar
  • 28 Leyon JJ, Littlehales T, Rangarajan B, Hoey ET, Ganeshan A. Endovascular embolization: review of currently available embolization agents. Curr Probl Diagn Radiol 2014; 43 (01) 35-53
    CrossrefPubMedGoogle Scholar
  • 29 Abud DG, Mounayer C, Benndorf G, Piotin M, Spelle L, Moret J. Intratumoral injection of cyanoacrylate glue in head and neck paragangliomas. AJNR Am J Neuroradiol 2004; 25 (09) 1457-1462
    PubMedGoogle Scholar
  • 30 Gemmete JJ, Patel S, Pandey AS. et al. Preliminary experience with the percutaneous embolization of juvenile angiofibromas using only ethylene-vinyl alcohol copolymer (Onyx) for preoperative devascularization prior to surgical resection. AJNR Am J Neuroradiol 2012; 33 (09) 1669-1675
    CrossrefPubMedGoogle Scholar
  • 31 Wang C, Ching EC, Hui FK. Aneurysm coil embolization: cost per volumetric filling analysis and strategy for cost reduction. J Neurointerv Surg 2016; 8 (05) 541-543
    CrossrefPubMedGoogle Scholar
  • 32 Wali AR, Park CC, Santiago-Dieppa DR, Vaida F, Murphy JD, Khalessi AA. Pipeline embolization device versus coiling for the treatment of large and giant unruptured intracranial aneurysms: a cost-effectiveness analysis. Neurosurg Focus 2017; 42 (06) E6
    CrossrefPubMedGoogle Scholar
  • 33 Niola R, Giurazza F, Torbica A, Schena E, Silvestre M, Maglione F. Predelivery uterine arteries embolization in patients with placental implant anomalies: a cost-effective procedure. Radiol Med (Torino) 2017; 122 (01) 77-79
    CrossrefPubMedGoogle Scholar