Wegner Inge, Vincent Robert, Derks Laura S M, Rauh Simone P, Heymans Martijn W, Stegeman Inge, Grolman Wilko
Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
Laryngoscope. 2018 Oct;128(10):2390-2396. doi: 10.1002/lary.27132. Epub 2018 Mar 9.
OBJECTIVES/HYPOTHESIS: To develop a prediction model that can accurately predict the chance of success following revision stapes surgery in patients with recurrent or persistent otosclerosis at 2- to 6-months follow-up and to validate this model internally.
A retrospective cohort study of prospectively gathered data in a tertiary referral center.
The associations of 11 prognostic factors with treatment success were tested in 705 cases using multivariable logistic regression analysis with backward selection. Success was defined as a mean air-bone gap closure to 10 dB or less. The most relevant predictors were used to derive a clinical prediction rule to determine the probability of success. Internal validation by means of bootstrapping was performed. Model performance indices, including the Hosmer-Lemeshow test, the area under the receiver operating characteristics curve (AUC), and the explained variance were calculated.
Success was achieved in 57.7% of cases at 2- to 6-months follow-up. Certain previous surgical techniques, primary causes of failure leading up to revision stapes surgery, and positions of the prosthesis placed during revision surgery were associated with higher success percentages. The clinical prediction rule performed moderately well in the original dataset (Hosmer-Lemeshow P = .78; AUC = 0.73; explained variance = 22%), which slightly decreased following internal validation by means of bootstrapping (AUC = 0.69; explained variance = 13%).
Our study established the importance of previous surgical technique, primary cause of failure, and type of the prosthesis placed during the revision surgery in predicting the probability of success following stapes surgery at 2- to 6-months follow-up.
2b. Laryngoscope, 128:2390-2396, 2018.
目的/假设：开发一种预测模型，该模型能够准确预测复发性或持续性耳硬化症患者在翻修镫骨手术后2至6个月随访时的成功几率，并在内部验证该模型。
在一家三级转诊中心对前瞻性收集的数据进行回顾性队列研究。
使用向后选择的多变量逻辑回归分析，在705例病例中测试11个预后因素与治疗成功之间的关联。成功定义为平均气骨导间距缩小至10dB或更小。使用最相关的预测因素得出临床预测规则，以确定成功的概率。通过自抽样法进行内部验证。计算模型性能指标，包括Hosmer-Lemeshow检验、受试者操作特征曲线下面积（AUC）和解释方差。
在2至6个月的随访中，57.7%的病例取得了成功。某些先前的手术技术、导致翻修镫骨手术失败的主要原因以及翻修手术期间放置的假体位置与较高的成功率相关。临床预测规则在原始数据集中表现中等（Hosmer-Lemeshow P = 0.78；AUC = 0.73；解释方差 = 22%），在通过自抽样法进行内部验证后略有下降（AUC = 0.69；解释方差 = 13%）。
我们的研究确定了先前手术技术、失败的主要原因以及翻修手术期间放置的假体类型在预测镫骨手术后2至6个月随访时成功概率方面的重要性。
2b。《喉镜》，2018年，第128卷，第2390 - 2396页。
