← Back to Previous Page

 

S183: LOWER SOCIOECONOMIC STATUS INCREASES THE POTENTIAL FOR OPERATIVE DEBRIDEMENT AFTER PEDIATRIC ENDOSCOPIC ENDONASAL SKULL BASE SURGERY.
Megan E McNutt¹; Isaac Kistler, MS²; Haley Ellett, MS, RN, CPNPPC²; Patrick Walz, MD, FACS, FAAP²; ¹The Ohio State University; ²Nationwide Children's Hospital

Introduction: Operative debridement is used to clear the sinonasal cavity and assess the surgical site after the expanded endonasal approach (EEA) for resection of skull base pathologies. The factors leading to the need for operative debridement as compared to in-office debridement are not well understood.

Objectives: The objectives of this study were to assess how social determinants of health (SDOH) indicated by Child Opportunity Index (COI), age, and reconstruction extent impact the need for operative debridement after pediatric EEA.

Methods: This study was conducted at a tertiary pediatric hospital as a single-institution retrospective chart review of all patients undergoing EEA from January 2007 to May 2025. Data collection included patient demographics and history, preoperative symptoms, intraoperative techniques, perioperative variables, postoperative course, location of debridement, and COI. Patients surviving beyond two weeks from surgery were included.

Results: Eighty patients were included. Median age of the cohort was 13.8 years, and 55% were male. Non-Hispanic white patients made up 77% of the cohort. Patients with a nasoseptal flap (NSF) raised but not used had significantly higher odds of requiring operative debridement compared to those who did not have a flap raised or used (OR = 22.0, 95% CI: 1.51–637, p = 0.031). Similarly, those with an NSF used had even greater odds of operative debridement versus patients with no NSF raised (OR = 24.6, 95% CI: 4.64–457, p = 0.002). Patients with an overall COI level of "Very Low" had increased odds of operative debridement than those with "Very High" COI (OR = 7.33, 95% CI: 0.97–70.3, p = 0.066). Within the socioeconomic subdomain, "Very Low", COI was associated with significantly higher odds of operative debridement versus "Very High" COI (OR = 13.8, 95% CI: 1.75–171, p = 0.021). Age (OR = 0.95, 95% CI: 0.87–1.03, p = 0.2) and gender (OR = 1.25, 95% CI: 0.50–3.10, p = 0.6) were not associated with the need for operative debridement.

Discussion and Conclusion: Increased surgical extent and lower SDOH may increase the odds of intraoperative debridement after pediatric EEA. Although generalizability is limited due to wide confidence intervals, the surgical complexity or characteristics associated with raising and using an NSF may contribute to higher odds of needing additional removal of clot, packing material, and secretions in the operating room after surgery. Understanding this relationship is important for surgical planning and patient counseling.  Disparities in SDOH may impact post-operative courses for pediatric patients undergoing EEA. SDOH factors should be considered in pre-operative risk assessments and may reflect broader systemic inequalities that impact patient outcomes. Future research should investigate the relationship between COI, SDOH and post-surgical course and whether targeted interventions could limit these disparities.

 

← Back to Previous Page