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Comparing 30-Day Morbidity and Mortality in Pediatric and Adult Otologic Surgery
Zachary G Schwam1, Elias Michaelides2, Jennifer R Schwam3
11 Yale School of Medicine, New Haven, Connecticut, USA.
Insights
Pediatric and adult otologic surgery share similar low complication rates, with most adverse events occurring post-discharge. Adults had more infectious complications, while children treated by pediatric specialists faced higher readmission risks.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Health Services Research
Background:
- Postoperative adverse events in otologic surgery require careful consideration across different age groups.
- Understanding age-related differences in complication timing and rates is crucial for optimizing patient care.
- Existing literature may lack comprehensive comparisons between pediatric and adult otologic surgical outcomes.
Purpose of the Study:
- To compare the timing and incidence of postoperative adverse events in pediatric versus adult patients undergoing specific otologic procedures.
- To identify risk factors associated with adverse events, readmissions, and reoperations in these populations.
Main Methods:
- An administrative database study utilizing the National Surgical Quality Improvement Program (NSQIP) and NSQIP-Pediatric (NSQIP-P).
- Data extracted for 819 adults and 7020 children undergoing tympanoplasty and tympanomastoidectomy between 2005-2014.
- Statistical analyses included simple summary statistics, chi-squared tests, and multivariable logistic regression.
Main Results:
- Overall adverse event rates were similar between adults (2.9%) and children (2.3%).
- Adults had a higher incidence of infectious complications (0.4% vs 0.0%).
- Most complications (83.7%) occurred after hospital discharge. Children treated by pediatric otolaryngologists had higher readmission rates (OR, 2.80). Tympanomastoidectomy and concurrent procedures increased reoperation odds.
Conclusions:
- Both adult and pediatric otologic surgeries demonstrate comparable safety profiles with low overall complication rates.
- The majority of adverse events manifest post-discharge, highlighting the need for robust follow-up care.
- Specific procedures and surgical specialization influence readmission and reoperation risks.
Abstract:
Objective To determine differences in timing and rate of postoperative adverse events among pediatric and adult populations undergoing specific otologic procedures. Study Design Administrative database study. Setting Multi-institutional database. Subjects and Methods The National Surgical Quality Improvement Program (NSQIP) and NSQIP-Pediatric (NSQIP-P) were used to extract data from 819 adults (years 2005-2010) and 7020 children (years 2012-2014) undergoing tympanoplasty and (tympano)mastoidectomy, respectively. Simple summary statistics, χ2, and multivariable logistic regression analyses were performed. Results There were no significant differences in overall adverse event rates between adults (2.9%) and children (2.3%) ( P = .233). Adults experienced infectious complications more frequently than did children (0.4% vs 0.0%, P = .002). Postdischarge complications accounted for 83.7% of all complications. Children treated by pediatric otolaryngologists had higher readmission rates (odds ratio [OR], 2.80; 95% confidence interval [CI], 1.20-3.60; P = .002). Tympanomastoidectomy was associated with higher odds of reoperation (OR, 1.02; 95% CI, 1.01-1.03; P < .001), as was undergoing a concurrent procedure that did not include myringotomy (OR, 3.38; 95% CI, 1.47-7.79; P = .004). Conclusion Both adult and pediatric otologic surgery are safe, with patients experiencing similarly low complication rates. Most adverse events occur after discharge.
