Shew Matthew A, Muelleman Thomas, Villwock Mark, Muelleman Robert J, Sykes Kevin, Staecker Hinrich, Lin James L
Department of Otolaryngology Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas.
Otol Neurotol. 2018 Jan;39(1):54-58. doi: 10.1097/MAO.0000000000001609.
Tympanoplasty with or without concurrent therapeutic mastoidectomy is a controversial topic in the management of chronic ear disease. We sought to describe whether there is a significant difference in postoperative complications.
Retrospective cohort study.
American College of Surgeons National Surgical Quality Improvement Program public files.
Current procedural terminology codes were used to identify patients with chronic ear disease undergoing tympanoplasty ± concurrent mastoidectomy in the 2011 to 14 American College of Surgeons National Surgical Quality Improvement Program files.
Therapeutic.
Variables were compared with χ, Fischer's exact, and Mann-Whitney U tests, as appropriate to analyze postoperative complications between tympanoplasty with or without concurrent mastoidectomy. To account for confounding factors, presence of a complication was analyzed in binary logistic regression. Analysis considered sex, hypertension, obesity, advanced age, diabetes, smoking status, American Society of Anesthesiologists Physical status, procedure.
There were 4,087 patients identified meeting criteria (tympanoplasty = 2,798, tympanomastoidectomy = 1,289). There was no statistical difference in postoperative complications (tympanoplasty n = 49 [1. 8%], tympanomastoidectomy n = 33 [2. 6%]; p = 0. 087) or return to the operating room (tympanoplasty = 4 [0. 1%], tympanomastoidectomy = 6 [0. 5%]; p = 0. 082). Binary logistic regression demonstrated smoking as a predictor of a postoperative complication (OR: 1. 758, 95% CI: 1. 084-2. 851; p = 0. 022), while concurrent mastoidectomy did not significantly increase the risk of complication (OR: 1. 440, 95% CI: 0. 915-2. 268; p = 0. 115). There was a significant difference in mean operative time between tympanoplasty and tympanomastoidectomy: 85.7 versus 154.23 min, p < 0. 001.
In the management of chronic ear disease, tympanoplasty with concurrent mastoidectomy increases time under anesthesia, but it is not associated with any increased postoperative complications compared with tympanoplasty alone.
伴有或不伴有同期治疗性乳突切除术的鼓室成形术在慢性耳部疾病的治疗中是一个存在争议的话题。我们试图描述术后并发症是否存在显著差异。
回顾性队列研究。
美国外科医师学会国家外科质量改进计划公共档案。
使用当前手术操作术语编码，在美国外科医师学会2011至2014年国家外科质量改进计划档案中识别接受鼓室成形术±同期乳突切除术的慢性耳部疾病患者。
治疗性。
根据情况，采用χ²检验、费舍尔精确检验和曼-惠特尼U检验对变量进行比较，以分析伴有或不伴有同期乳突切除术的鼓室成形术之间的术后并发症。为了考虑混杂因素，在二元逻辑回归中分析并发症的存在情况。分析考虑了性别、高血压、肥胖、高龄、糖尿病、吸烟状况、美国麻醉医师协会身体状况、手术。
共识别出4087例符合标准的患者（鼓室成形术 = 2798例，鼓室乳突联合手术 = 1289例）。术后并发症（鼓室成形术n = 49例[1.8%]，鼓室乳突联合手术n = 33例[2.6%]；p = 0.087）或返回手术室情况（鼓室成形术 = 4例[0.1%]，鼓室乳突联合手术 = 6例[0.5%]；p = 0.082）无统计学差异。二元逻辑回归显示吸烟是术后并发症的一个预测因素（比值比：1.758，95%置信区间：1.084 - 2.851；p = 0.022），而同期乳突切除术并未显著增加并发症风险（比值比：1.440，95%置信区间：0.915 - 2.268；p = 0.115）。鼓室成形术和鼓室乳突联合手术的平均手术时间存在显著差异：85.7分钟对154.23分钟，p < 0.001。
在慢性耳部疾病的治疗中，鼓室成形术联合同期乳突切除术会增加麻醉时间，但与单纯鼓室成形术相比，术后并发症并未增加。
