Roxbury Christopher R, Yang Jingyan, Salazar Jose, Shah Rahul K, Boss Emily F
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.
Otolaryngol Head Neck Surg. 2015 May;152(5):790-5. doi: 10.1177/0194599815575711. Epub 2015 Mar 24.
Describe safety and postoperative sequelae of pediatric otologic surgery and identify predictive factors for postoperative events.
Retrospective cohort study of the American College of Surgeons National Surgery Quality Improvement Program-Pediatric (NSQIP-P) database.
Data pooled from the 2012 NSQIP-P public use file (50 institutions).
Current procedural terminology codes were used to identify children who underwent otologic surgery. Variables of interest included demographics and 30-day postoperative events grouped as reoperation, readmission, and complication. Event rates were determined and prevalence of events compared by procedure type and within patient subgroups according to chi-square analysis. Multivariate logistic regression evaluated predictive factors for postoperative events.
Of 37,319 pediatric operations, 2556 (6.8%) were otologic procedures. The most common procedure was tympanoplasty (n = 893, 34.9%), followed by myringoplasty (n = 741, 30.0%), cochlear implantation (n = 464, 18.2%), and tympanomastoidectomy (n = 458, 17.9%). There were 9 reoperations (0.4%), 32 readmissions (1.3%), and 18 complications (0.7%). Children undergoing tympanomastoidectomy or cochlear implantation were more likely to be readmitted irrespective of other factors (odds ratio = 5.5, P = .010; odds ratio = 3.5, P = .083). Children <3 years old were 4 times more likely to be readmitted than older children (odds ratio = 4.4, P < .001).
Pediatric otologic procedures are common and have low rates of global 30-day postoperative events. Tympanomastoidectomy and cochlear implantation have the highest risk of 30-day readmission. Young children (<3 years) are more likely to be readmitted following these procedures. Further optimization of the NSQIP-P to include specialty and procedure-specific variables is necessary to assess complete, actionable outcomes of pediatric otologic surgery, however the present study provides a foundation to build upon for safety and quality improvement initiatives in pediatric otology.
描述小儿耳科手术的安全性及术后后遗症，并确定术后事件的预测因素。
对美国外科医师学会国家外科质量改进计划 - 儿科（NSQIP - P）数据库进行回顾性队列研究。
汇总自2012年NSQIP - P公共使用文件（50家机构）的数据。
使用当前操作术语代码识别接受耳科手术的儿童。感兴趣的变量包括人口统计学数据以及术后30天内的事件，这些事件分为再次手术、再次入院和并发症。根据卡方分析确定事件发生率，并按手术类型和患者亚组比较事件患病率。多因素逻辑回归评估术后事件的预测因素。
在37319例儿科手术中，2556例（6.8%）为耳科手术。最常见的手术是鼓室成形术（n = 893，34.9%），其次是鼓膜成形术（n = 741，30.0%）、人工耳蜗植入术（n = 464，18.2%）和鼓室乳突切除术（n = 458，17.9%）。有9例再次手术（0.4%）、32例再次入院（1.3%）和18例并发症（0.7%）。无论其他因素如何，接受鼓室乳突切除术或人工耳蜗植入术的儿童更有可能再次入院（比值比 = 5.5，P = 0.010；比值比 = 3.5，P = 0.083）。3岁以下儿童再次入院的可能性是大龄儿童的4倍（比值比 = 4.4，P < 0.001）。
小儿耳科手术很常见，30天术后总体事件发生率较低。鼓室乳突切除术和人工耳蜗植入术30天再次入院风险最高。幼儿（<3岁）在这些手术后更有可能再次入院。有必要进一步优化NSQIP - P以纳入专科和特定手术变量，从而评估小儿耳科手术完整、可采取行动的结果，然而本研究为小儿耳科学中安全和质量改进举措奠定了基础。
