Gordon Steven A, Aylward Alana, Patel Neil S, Bowers Christian, Presson Angela P, Smith Ken R, Foster Norman L, Gurgel Richard K
Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
OTO Open. 2021 Sep 24;5(3):2473974X211044084. doi: 10.1177/2473974X211044084. eCollection 2021 Jul-Sep.
To evaluate whether frailty or age increases the risk of postoperative complications following cochlear implant (CI) surgery.
Retrospective cohort study.
Tertiary academic center.
An evaluation of all adult patients undergoing cochlear implantation between 2006 and 2020 was performed. The 5-item Modified Frailty Index (mFI-5, comprising preoperative history of pulmonary disease, heart failure, hypertension, diabetes, and partially/totally dependent functional status) was calculated for all patients included in analysis in addition to demographic characteristics. The primary outcome was postoperative complications following CI within a 3-month period. Major complications included myocardial infarction, bleeding, and cerebrospinal fluid leak, among others. Predictors of postoperative complications were examined using multivariable logistic regression reporting odds ratios (ORs) and 95% CIs.
There were 520 patients included for review with a median age of 68 (range, 18-94) years and a slight male predominance (n = 283, 54.4%). There were 340 patients (65.4%) who were robust (nonfrail) with an mFI of 0, while 180 (34.6%) had an mFI of ≥1. There were 20 patients who experienced a postoperative complication (3.85%). There was no statistically significant association between postoperative complications as a result of preoperative frailty (OR, 1.56; 95% CI, 0.98-2.48, = .06) or age as a continuous variable (OR, 0.99; 95% CI, 0.97-1.02, = .51).
CI is safe for elderly and frail patients and carries no additional risk of complications when compared to younger, healthier patients. While medical comorbidities should always be considered perioperatively, this study supports the notion that implantation is low risk in older, frail patients.
评估虚弱或年龄是否会增加人工耳蜗（CI）植入术后并发症的风险。
回顾性队列研究。
三级学术中心。
对2006年至2020年间所有接受人工耳蜗植入的成年患者进行评估。除人口统计学特征外，还为纳入分析的所有患者计算了5项改良虚弱指数（mFI-5，包括肺部疾病、心力衰竭、高血压、糖尿病的术前病史以及部分/完全依赖的功能状态）。主要结局是CI术后3个月内的并发症。主要并发症包括心肌梗死、出血和脑脊液漏等。使用多变量逻辑回归分析报告比值比（OR）和95%置信区间（CI），以检验术后并发症的预测因素。
共有520例患者纳入回顾，中位年龄为68岁（范围18 - 94岁），男性略占优势（n = 283，54.4%）。340例患者（65.4%）身体强壮（非虚弱），mFI为0，而180例（34.6%）的mFI≥1。有20例患者发生了术后并发症（3.85%）。术前虚弱导致的术后并发症之间（OR，1.56；95% CI，0.98 - 2.48，P = 0.06）或年龄作为连续变量（OR，0.99；95% CI，0.97 - 1.02，P = 0.51）之间无统计学显著关联。
CI对老年和虚弱患者是安全的，与年轻、健康的患者相比，不会增加并发症的额外风险。虽然围手术期应始终考虑合并症，但本研究支持老年、虚弱患者植入手术风险较低的观点。
