Chronic otitis media surgery and re-operation risk factor analysis: A nationwide retrospective cohort study of 18 895 patients
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Published on: May 23, 2021
Chien-Fu Yeh1,2, Chuan-Song Wu3, Chii-Yuan Huang1,2
1a Department of Otolaryngology Head & Neck Surgery , Taipei Veterans General Hospital , Taipei , Taiwan ;
Conclusion:
Patients with risk factors including younger age, mastoiditis, external ear disease, treatment by older surgeons, and concomitant mastoidectomy should receive detailed management to minimize the probability of re-operation for chronic otitis media (COM).
Objectives:
Although COM remains a common ear disease requiring surgical intervention, its re-operation risks are less well-documented. This study aimed to compare patients with COM who underwent re-operation and those patients with no re-operation, and identify the risks of re-operation.
Method:
This retrospective cohort study analyzed the trend of COM surgery from 1999-2009, and identified the re-operation risks of 18 895 patients with COM who underwent surgery from 2002-2006 using the National Health Insurance Research Database in Taiwan.
Results:
Among the study population, 129 patients underwent revision surgery during a 5.5 ± 1.5 year follow-up period. A univariate logistic regression analysis showed that the re-operation rate was significantly higher in patients under 18 years of age, those with mastoiditis, disorders of external ear, treatment by surgeons of 50-64 years of age, use of a very high volume surgeon, and combined surgery with mastoidectomy. A multivariate analysis further limited the re-operation risk factors to younger patients, those with mastoiditis, external ear disorders, treatment by older surgeons, and concomitant mastoidectomy.
Insights
Younger patients, mastoiditis, external ear disease, and undergoing mastoidectomy increase chronic otitis media (COM) re-operation risk. Detailed management is crucial to minimize repeat surgeries for COM patients.
Area of Science:
- Otolaryngology
- Surgical Outcomes Research
- Epidemiology
Background:
- Chronic otitis media (COM) frequently requires surgical intervention.
- Re-operation risks associated with COM surgery are not extensively documented.
- Understanding these risks is vital for improving patient management and surgical planning.
Purpose of the Study:
- To compare patients with COM who underwent re-operation versus those who did not.
- To identify specific risk factors associated with re-operation in COM patients.
- To inform strategies for reducing the need for revision surgery.
Main Methods:
- Retrospective cohort study analyzing COM surgery trends (1999-2009).
- Utilized Taiwan's National Health Insurance Research Database for patient data (2002-2006).
- Identified re-operation risks in 18,895 COM patients.
Main Results:
- 129 patients (0.68%) required revision surgery over a 5.5-year follow-up.
- Univariate analysis indicated higher re-operation rates in younger patients, those with mastoiditis, external ear disease, and those treated by older or high-volume surgeons, or undergoing concomitant mastoidectomy.
- Multivariate analysis confirmed younger age, mastoiditis, external ear disorders, treatment by older surgeons, and concomitant mastoidectomy as significant risk factors.
Conclusions:
- Younger age, mastoiditis, external ear disease, treatment by older surgeons, and concomitant mastoidectomy are key risk factors for COM re-operation.
- Targeted management strategies for these patient groups can help minimize re-operation probability.
- This research provides critical insights for optimizing surgical outcomes in chronic otitis media.
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