Publications by authors named "Ronak Rahmanian"

8 Publications

  • Page 1 of 1

Predictors of Pediatric Tracheostomy Outcomes in the United States.

Otolaryngol Head Neck Surg 2020 09 21;163(3):591-599. Epub 2020 Apr 21.

Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, California, USA.

Objectives: To investigate the outcomes of pediatric tracheostomy as influenced by demographics and comorbidities.

Study Design: Retrospective national database review.

Setting: Fifty-two children's hospitals across the United States.

Subjects And Methods: Hospitalization records from Pediatric Health Information System database dated 2010 to 2018 with patients younger than 18 years and procedure codes for tracheostomy were extracted. The primary outcome was total length of stay. The secondary outcomes were 30-day readmission, mortality, and posttracheostomy length of stay.

Results: A total of 14,155 children were included in the analysis. The median total length of stay was 77 days and increased from 59 to 103 days between 2010 and 2018 ( < .001). The median posttracheostomy length of stay was 34 days and also increased from 27 to 49 days ( < .001). On multivariate regression analyses, the total and posttracheostomy lengths of stay were significantly increased in children younger than 1 year, patients of black race, hospitals in the non-West regions, those discharged to home, and those with comorbidities. Socioeconomic indicators such as insurance type and estimated household income were associated with no difference or small effect sizes. Regions and comorbidities were associated with differences in 30-day readmission (overall 26%), while in-hospital mortality was primarily associated with age and comorbidities (overall 8.6%).

Conclusion: Pediatric tracheostomy requires substantial health care resources with length of stay escalating over recent years. Age, race, region, discharge destination, and comorbidities were associated with differences in length of stay.
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http://dx.doi.org/10.1177/0194599820917620DOI Listing
September 2020

Pharyngoesophageal reconstruction with the gastric pull-up: Functional outcomes in a cohort of 49 patients.

Clin Otolaryngol 2020 03 14;45(2):297-301. Epub 2020 Jan 14.

Division of Otolaryngology-Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada.

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http://dx.doi.org/10.1111/coa.13503DOI Listing
March 2020

Revisiting the gastric pull-up for pharyngoesophageal reconstruction: A systematic review and meta-analysis of mortality and morbidity.

J Surg Oncol 2016 Dec 24;114(8):907-914. Epub 2016 Oct 24.

Division of Otolaryngology-Head and Neck Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada.

Gastric pull-up (GPU) is among the oldest techniques for reconstructing the pharyngoesophageal junction following cancer resection. This review examines morbidity and mortality rates following GPU pharyngoesophageal junction reconstruction from 1959 until present: 77 studies, 2,705 patients. The odds of mortality, anastomotic complications, and other complications decreased by 37.2% (95%CI = 28.0-45.3%; P < 0.0001), 8.0% (95%CI = -2.1 to 17.1%; P = 0.12), 21.0% (95%CI 3.5-35.2%; P = 0.021) per decade respectively. J. Surg. Oncol. 2016;114:907-914. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/jso.24477DOI Listing
December 2016

False carina: a distinct variant of tracheal bronchus.

Int J Pediatr Otorhinolaryngol 2015 Apr 25;79(4):623-8. Epub 2015 Jan 25.

Division of Pediatric Otolaryngology-Head and Neck Surgery, Faculty of Medicine, University of British Columbia and B.C. Children's Hospital, 4480 Oak Street, Vancouver, BC, Canada V6H 3V4. Electronic address:

Tracheal-bronchus is an aberrant bronchus arising from the lateral tracheal wall, superior to the carina. A "False-carina" can be classified as a sub-type. This clinical entity will be defined and the clinical presentation, diagnosis and management of five patients with variations of the anatomical definition of a False-carina, identified at our institution, will be reviewed. Congenital bronchial abnormalities, including False-carina, have important implications in the overall management of the airway. Management can range from expectant in asymptomatic patients to surgical intervention in cases of recurrent respiratory infections. Awareness and understanding of this clinical entity allows for timely investigation, diagnosis and appropriate intervention.
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http://dx.doi.org/10.1016/j.ijporl.2015.01.023DOI Listing
April 2015

Calcific tendonitis of the longus colli muscle: a noninfectious cause of retropharyngeal fluid collection.

Case Rep Otolaryngol 2014 24;2014:286190. Epub 2014 Nov 24.

Division of Otolaryngology, Head & Neck Surgery, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 4th Floor, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9.

Calcific tendonitis of the longus colli (CTLC) muscle is an underrecognized cause of spontaneous acute or subacute neck pain, dysphagia, or odynophagia. Imaging may reveal a retropharyngeal fluid collection leading to the presumed diagnosis of retropharyngeal abscess. Recognition of this uncommon presentation is important to prevent unnecessary surgical incision and drainage. A 44-year-old otherwise healthy male presented with a 2-week history of progressive neck pain, stiffness, and odynophagia. A noncontrast CT scan of the cervical spine revealed a retropharyngeal fluid collection with a small area of calcification anterior to C2. There was a presumed diagnosis of retropharyngeal abscess. The patient was afebrile with normal vital signs. Flexible nasolaryngoscopy was unremarkable. C-reactive protein was elevated but all other bloodwork was normal with no evidence of an infective process. A CT scan was repeated with IV contrast showing no enhancement around the fluid collection. A diagnosis of CTLC was made. The patient was successfully managed with a short course of intravenous steroids and oral NSAIDs with complete resolution of symptoms. Clinically CTLC can mimic more serious disease processes. Identifying pathognomonic imaging findings often confirms the diagnosis. Awareness of this condition by the otolaryngologist will ensure proper patient management and avoidance of unnecessary procedures.
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http://dx.doi.org/10.1155/2014/286190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260433PMC
December 2014

Non-fatal extensive cerebral venous thrombosis as a complication of adenotonsillectomy.

Int J Pediatr Otorhinolaryngol 2015 Feb 25;79(2):254-8. Epub 2014 Nov 25.

Division of Pediatric Otolaryngology-Head and Neck Surgery, B.C. Children's Hospital, K2-184, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada. Electronic address:

Adenotonsillectomy, a common ambulatory surgical procedure performed in the pediatric population, may at times lead to serious postoperative complications. The case of a 10-year-old with extensive cerebral venous thrombosis (CVT) following routine adenotonsillectomy is presented and the likely risk factors are discussed. Recent literature regarding CVT in children will be reviewed. To our knowledge, there are no previous reports in the Otolaryngology literature of extensive CVT as a complication of adenotonsillectomy. This clinical entity is more common than previously thought. Awareness and a high index of suspicion and initiation of timely management can reduce the risk of potentially fatal outcomes.
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http://dx.doi.org/10.1016/j.ijporl.2014.11.016DOI Listing
February 2015

Use of the SNOT-22 and UPSIT to appropriately select pediatric patients with cystic fibrosis who should be referred to an otolaryngologist: cross-sectional study.

JAMA Otolaryngol Head Neck Surg 2014 Oct;140(10):934-9

Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.

Importance: Sinonasal disease and, specifically, nasal polyps, occur frequently in children with cystic fibrosis (CF). As survival rates have improved, it has become imperative that otolaryngologists become involved in the care of patients with CF to provide appropriate medical and surgical interventions for sinonasal disease. Despite significant variability in the subjective reporting of clinical symptoms, previous work has suggested there may be a relationship between clinical indicators and sinonasal disease in this population.

Objective: To determine whether the 22-item Sino-Nasal Outcome Test (SNOT-22), the University of Pennsylvania Smell Identification Test (UPSIT), and other measures of sinonasal disease could be used to predict the presence of subclinical nasal polyps in children with CF.

Design, Setting, And Participants: This was a cross-sectional study performed from May 2012 through April 2013 at a cystic fibrosis clinic at BC Children's Hospital in Vancouver, British Columbia, Canada. There were 72 eligible children with CF for this study (with a confirmed diagnosis of CF based on genetic testing; their ages ranged from 6 to 18 years, and they were not actively being treated by an otolaryngologist). Thirty-seven of these patients (23 males, 14 females) consented to participate in this study. Twenty-three declined participation, and 12 could not be contacted.

Main Outcomes And Measures: Potential clinical predictors for the presence of subclinical nasal polyps were determined a priori. All 37 recruited participants completed a full study assessment. Nasal endoscopy (the gold standard) was performed to determine the presence of nasal polyps. Potential predictors that were assessed included age, sex, genotype, pancreatic function, SNOT-22 and UPSIT scores, oral culture swab result, and severity of forced expiratory volume in 1 second (FEV(1)).

Results: A SNOT-22 score of greater than 11 was the only statistically significant predictor of nasal polyps (P = .04). The positive predictive value was 68.1%, the negative predictive value was 66.7%, and the positive likelihood ratio was 1.82.

Conclusions And Relevance: Given that the SNOT-22 is easy to administer and inexpensive, this sinus disease-specific questionnaire seems to be an appropriate tool for routine use by respirologists when assessing patients with CF to help predict subclinical nasal polyps.
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http://dx.doi.org/10.1001/jamaoto.2014.1650DOI Listing
October 2014

Longitudinal analysis of genotype distribution of influenza A virus from 2003 to 2005.

J Clin Microbiol 2006 Oct;44(10):3583-8

BC Centre for Disease Control, 655 W12th Ave., Vancouver, BC V5Z 4R4, Canada.

Influenza A viruses cause yearly epidemics, in part, due to their ability to overcome immunity from previous infections through acquisition of mutations. Amino acid sequences encoded by genes 4 (HA), 6 (NA), 7 (M), and 8 (NS) from 77 H3N2 influenza A isolates, collected between November 2003 and March 2005, were analyzed to determine the extent to which the viruses mutated within epidemic periods and between the epidemics. Nucleotide and amino acid sequences were stable throughout the epidemics but experienced substantial changes between epidemics. Major changes occurred in the HA gene in 5 to 7 amino acids and the NA gene in 11 to 13 amino acids and changes of 5 amino acids occurred in the M and NS genes. In the HA gene, changes occurred in sites known to be epitopes that determine the hemagglutination inhibition reactivity, and these were shown to be associated with a change of strain from A/Fujian/411/2002-like to A/California/7/2004-like viruses. Our findings indicate that genotype determination promises to be a rapid approach for detecting new strains of influenza A viruses in a population.
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http://dx.doi.org/10.1128/JCM.02601-05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1594783PMC
October 2006
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