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  • Title: Safety of Adult Ambulatory Direct Laryngoscopy: Revisits and Complications.
    Author: Orosco RK, Lin HW, Bhattacharyya N.
    Journal: JAMA Otolaryngol Head Neck Surg; 2015 Aug; 141(8):685-9. PubMed ID: 26135845.
    Abstract:
    IMPORTANCE: Direct laryngoscopy, once an inpatient procedure, is now commonly performed in the outpatient setting. To ensure that safety follows the adoption of novel techniques and practice patterns, it is important to analyze the complication and revisit rates of these ambulatory surgery practices. OBJECTIVE: To determine revisit rates and complications after ambulatory adult direct laryngoscopy procedures. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cross-sectional analysis of cases of adult patients who had undergone a direct laryngoscopic procedure extracted from multistate ambulatory surgery and hospital databases (State Ambulatory Surgery Databases for New York, Florida, Iowa, and California for 2010 and 2011). The analysis was performed on December 1, 2014. Index cases were linked to the corresponding State Emergency Department Databases and the State Inpatient Databases for visit encounters occurring within a 7-day postoperative window. All index cases were ambulatory surgery, without overnight stay or 23-hour observation. PARTICIPANTS: Adult patients who had undergone a direct laryngoscopy procedure. EXPOSURES: Direct laryngoscopy performed in an ambulatory setting. Patients who underwent flexible laryngoscopy, lesion destruction, laryngectomy, cordectomy, or a secondary nonlaryngoscopy procedure were specifically excluded. MAIN OUTCOMES AND MEASURES: Data regarding sex, age, revisit occurrence with associated complications, and mortality were analyzed. RESULTS: A total of 7743 cases of ambulatory laryngoscopy were identified (mean age, 60.4 years; 61% were male). The 7-day revisit rate was 3.0% (232 revisits). Serious airway complications occurred in 0.27% of cases (n = 21) and accounted for 9.1% of revisits. The rates of other major complications and minor complications were 0.15% (n = 12) and 0.75% (n = 58), respectively. There were no cases of anoxic brain injury. Two deaths occurred at the time of the revisit (7-day mortality rate, 0.03%; 95% CI, 0.01%-0.09%). CONCLUSIONS AND RELEVANCE: Adult ambulatory direct laryngoscopy has a favorable safety profile. Serious airway complications occur in fewer than 3 patients per 1000 cases. The risk of death following outpatient laryngoscopy is extremely low. Outpatient laryngoscopy is not universally suited for all patients, and careful preoperative selection and counseling are imperative.
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