Publications by authors named "Rahul A Patel"

2 Publications

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Adverse Events Associated With Corticosteroid-Eluting Sinus Stents: A MAUDE Database Analysis.

Otolaryngol Head Neck Surg 2021 Apr 13:1945998211006930. Epub 2021 Apr 13.

Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.

Objective: Corticosteroid-eluting stents (CESs) are increasingly used after endoscopic sinus surgery to reduce the need for revision surgery, but their use is not without risks. The objective of this study is to describe adverse events related to CESs.

Study Design: Retrospective cross-sectional study.

Setting: The US Food and Drug Administration's MAUDE database (2011-2020; Manufacturer and User Facility Device Experience).

Methods: The MAUDE database was queried for reports of adverse events involving the use of CESs approved by the Food and Drug Administration, including Propel, Propel Mini, Propel Contour, and Sinuva (Intersect ENT).

Results: There were 28 reported adverse events in total, with all events being related to the Propel family of stents and none related to Sinuva stents. Overall, 22 were categorized as patient-related adverse events and 6 as device-related events. The most common adverse event was related to postoperative infection, accounting for 39% (n = 11) of all complications. Four of these patients developed periorbital cellulitis, and 5 developed a fungal infection. The second-most common adverse event was migration of the stent, representing 21% of all complications (n = 6). Overall, 8 patients (29%) in our cohort required reintervention in the operating room, with subsequent removal of the CES.

Conclusion: The most commonly reported adverse events were postoperative infection, including multiple cases of fungal infection, followed by migration of the stent. An increased awareness of the complications associated with CESs can be used to better inform patients during the consenting process as well as surgeons in their surgical decision making.
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April 2021

Role and Growth of Independent Medicare-Billing Otolaryngologic Advanced Practice Providers.

Otolaryngol Head Neck Surg 2021 Mar 9:194599821994820. Epub 2021 Mar 9.

Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA.

Objective: To evaluate the role and growth of independently billing otolaryngology (ORL) advanced practice providers (APPs) within a Medicare population.

Study Design: Retrospective cross-sectional study.

Setting: Medicare Provider Utilization and Payment Data: Physician and Other Supplier Data Files, 2012-2017.

Methods: This retrospective review included data and analysis of independent Medicare-billing ORL APPs. Total sums and medians were gathered for Medicare reimbursements, services performed, number of patients, and unique () codes used, along with geographic and sex distributions.

Results: There has been near-linear growth in number of ORL APPs (13.7% to 18.4% growth per year), with a 115.4% growth from 2012 to 2017. Similarly, total Medicare-allowed reimbursement (2012: $15,568,850; 2017: $35,548,446.8), total number of services performed (2012: 313,676; 2017: 693,693.7), and total number of Medicare fee-for-service (FFS) patients (2012: 108,667; 2017: 238,506) increased. Medians of per APP number of unique codes used, Medicare-allowed reimbursement, number of services performed, and number of Medicare FFS patients have remained constant. There were consistently more female APPs than male APPs (female APP proportion range: 71.3%-76.7%). Compared to ORL physicians, there was a significantly greater proportion of APPs practicing in a rural setting as opposed to urban settings (2017: APP proportion 13.6% vs ORL proportion 8.4%; < .001).

Conclusion: Although their scope of practice has remained constant, independently billing ORL APPs are rapidly increasing in number, which has led to increased Medicare reimbursements, services, and patients. ORL APPs tend to be female and are used more heavily in regions with fewer ORL physicians.
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March 2021