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Original Investigation |

Office-Based vs Traditional Operating Room Management of Recurrent Respiratory Papillomatosis Impact of Patient Characteristics and Disease Severity ONLINE FIRST

Emel Çadallı Tatar, MD1; Robbi A. Kupfer, MD2,3; Jonnae Y. Barry, MD4; Clint T. Allen, MD5; Albert L. Merati, MD2
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
2Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle
3Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, Ann Arbor
4Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Arizona Medical Center, Tucson
5Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University, Bethesda, Maryland
JAMA Otolaryngol Head Neck Surg. Published online September 22, 2016. doi:10.1001/jamaoto.2016.2724
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Importance  Management of recurrent respiratory papillomatosis (RRP) in adults has evolved to include office-based laser techniques.

Objective  To determine whether demographic or disease characteristics differ between patients undergoing office-based (office group) vs traditional operating room (OR group) surgical approaches for RRP.

Design, Setting, and Participants  This study was a medical record review of adult patients with RRP treated between January 2011 and September 2013 at a tertiary care center. Patients were divided into 2 groups according to the setting in which the patient had the most procedures during the past 2 years.

Main Outcomes and Measures  Demographic and disease characteristics were compared between patients receiving predominantly office-based vs predominantly OR management.

Results  Of 57 patients (47 male and 10 female, with a mean [SD] age of 53.5 [16.4] years) treated during the 2-year period, 34 patients underwent predominantly office-based management and 23 patients underwent predominantly OR management. Sex, age, and weight were not statistically significantly different between the 2 groups. Patients in the OR group had a younger age at RRP diagnosis (mean [SD], 28.7 [22.0] years in the OR group and 45.5 [20.5] years in the office group), with a mean difference of 16.8 years (95% CI, −28.3 to −5.4 years). Patients in the OR group also had a significantly higher Derkay score (mean [SD], 15.1 [5.7] in the OR group and 10.7 [5.0] in the office group), with a mean difference of 4.4 (95% CI, 1.6-7.3). No statistically significant differences in comorbidities were observed between the 2 groups except for type 1 or 2 diabetes, which was more common in the OR group. There were 5 patients (22%) with diabetes in the OR group and 1 patient (3%) with diabetes in the office group, with a mean difference of 19% (95% CI, 2.7%-35%). In a subanalysis that excluded patients with juvenile-onset RRP, Derkay score (mean [SD], 13.9 [4.5] in the OR group and 10.8 [5.1] in the office group), with a mean difference of 3.1 (95% CI, 0.5-6.1), and the incidence of diabetes (25% [4 of 16] in the OR group and 3% [1 of 31] in the office group), with a mean difference of 22% (95% CI, 3%-40%), remained significantly higher in the OR group, while age at diagnosis of RRP was no longer statistically significant (mean [SD], 40.2 [15.6] years in the OR group and 49.6 [16.4] years in the office group), with a mean difference of 9.4 years (95% CI, −19.4 to −0.7 years).

Conclusions and Relevance  There were no sex or age differences between patients with RRP treated in the office compared with those treated in the OR. Patients with earlier age at diagnosis of RRP and greater disease severity were more likely to be managed in the OR.

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Figure.
Office-Based Ablation of a Papilloma With Pulsed Potassium-Titanyl-Phosphate Laser

A, Shown are a small bulky lesion of the right anterior vocal fold, a small-surface papilloma on the right superior vocal fold, and a small surface papilloma on the left anterior vocal fold. B and C, Application of the laser. D, Most of the devascularized papilloma was debrided using the laser fiber. Remnants will slough off after several days.

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