Zhou Albert H, Chung Sei Y, Sylvester Michael J, Zaki Michael, Svider Peter S, Hsueh Wayne D, Baredes Soly, Eloy Jean Anderson
1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
2 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey.
Am J Rhinol Allergy. 2018 Nov;32(6):539-545. doi: 10.1177/1945892418801259. Epub 2018 Oct 1.
Epistaxis is common in elderly patients, occasionally necessitating hospitalization for the management of severe bleeds. In this study, we aim to explore the impact of nasal packing versus nonpacking interventions (cauterization, embolization, and ligation) on outcomes and complications of epistaxis hospitalization in the elderly.
The 2008-2013 National Inpatient Sample was queried for elderly patients (≥65 years) with a primary diagnosis of epistaxis and accompanying procedure codes for anterior and posterior nasal packing or nonpacking interventions.
A total of 8449 cases met the inclusion criteria, with 62.4% receiving only nasal packing and 37.6% receiving nonpacking interventions. On average, nonpacking interventions were associated with a 9.9% increase in length of stay and a 54.0% increase in hospital charges. Comorbidity rates did not vary between cohorts, except for diabetes mellitus, which was less common in the nonpacking cohort (26.6% vs 29.0%; P = .014). Nonpacking interventions were associated with an increased rate of blood transfusion (24.5% vs. 21.8%; P = .004), but no significant differences in rates of stroke, blindness, aspiration pneumonia, infectious pneumonia, thromboembolism, urinary/renal complications, pulmonary complications, cardiac complications, or in-hospital mortality. Comparing patients receiving ligation or embolization, no differences in length of stay, complications, or in-hospital mortality were found; however, embolization patients incurred 232.1% greater hospital charges ( P < .001).
Nonpacking interventions in the elderly do not appear to be associated with increased morbidity or mortality when compared to nasal packing only but appear to be associated with increased hospital charges and length of stay. Embolization in the elderly results in greater hospital charges but no change in outcome when compared to ligation.
鼻出血在老年患者中很常见，严重出血时偶尔需要住院治疗。在本研究中，我们旨在探讨鼻腔填塞与非填塞干预措施（烧灼、栓塞和结扎）对老年鼻出血住院患者的治疗效果和并发症的影响。
查询2008 - 2013年全国住院患者样本，选取年龄≥65岁、主要诊断为鼻出血且伴有前、后鼻腔填塞或非填塞干预措施相关手术编码的老年患者。
共有8449例病例符合纳入标准，其中62.4%仅接受鼻腔填塞，37.6%接受非填塞干预措施。平均而言，非填塞干预措施使住院时间延长9.9%，住院费用增加54.0%。除糖尿病外，各队列的合并症发生率无差异，糖尿病在非填塞队列中较不常见（26.6%对29.0%；P = 0.014）。非填塞干预措施与输血率增加相关（24.5%对21.8%；P = 0.004），但在中风、失明、吸入性肺炎、感染性肺炎、血栓栓塞、泌尿系统/肾脏并发症、肺部并发症、心脏并发症或住院死亡率方面无显著差异。比较接受结扎或栓塞的患者，在住院时间、并发症或住院死亡率方面未发现差异；然而，栓塞患者的住院费用高出232.1%（P < 0.001）。
与仅进行鼻腔填塞相比，老年患者的非填塞干预措施似乎与发病率或死亡率增加无关，但似乎与住院费用和住院时间增加有关。与结扎相比，老年患者的栓塞治疗导致更高的住院费用，但治疗效果无变化。
