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Safety of middle-ear day-surgery in children: A STROBE observational study
L Boullaud1, A Amelot2, C Aussedat3
1Service d'ORL et Chirurgie Cervico-Faciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France.
Insights
Pediatric major ear surgery is safe for outpatient management, with 95% success. Younger children (<36 months) undergoing these procedures require earlier scheduling and anti-nausea medication to minimize admission risks.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Outpatient Management
Background:
- Outpatient management of major otologic surgery in children is increasingly common.
- Factors influencing success and potential complications require analysis.
Purpose of the Study:
- To analyze factors for successful outpatient management of pediatric otologic surgery.
- To investigate unscheduled postoperative consultations and readmissions.
Main Methods:
- Retrospective observational study of 214 children undergoing major ear surgery over 3 years.
- Followed STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) recommendations.
- Analyzed clinical characteristics and surgical procedures.
Main Results:
- 95% of day-surgeries were successful; 5% required admission for nausea, pain, or delayed awakening.
- Younger age (<36 months) was associated with higher risk of admission (P=0.002).
- No readmissions occurred; 3% of cases had unscheduled consultations for minor bleeding or discharge.
Conclusions:
- Major otologic surgery is compatible with pediatric day-surgery.
- Younger children, often cochlear implant candidates, have a higher risk of admission.
- Early morning scheduling and aggressive postoperative nausea and vomiting prophylaxis are recommended for high-risk pediatric patients.
Objective:
The main objective of this pediatric study of otologic surgery was to analyze factors for success of outpatient management. The secondary objective was to study unscheduled postoperative consultations and readmissions.
Materials And Methods:
This retrospective observational study analyzed clinical characteristics and procedures in consecutive children undergoing major ear surgery over a 3-year period in a teaching hospital. The study followed STROBE recommendations.
Results:
We included 214 day-cases from a total population of 271 children. Median age was 109±44months (9years) [range: 8-196months (16years)]. In 57% of cases, the procedure was performed without mastoidectomy: 84 myringoplasties and 37 tympanoplasties. In 43% of cases, mastoidectomy was associated: 47 cochlear implants and 46 closed tympanoplasties for cholesteatoma. Ninety-five percent of day-surgeries were successful; in 5%, there was crossover to pediatric ENT department admission, for the following symptoms: postoperative nausea and vomiting in 3 cases, pain in 3, and late awakening in 5. Univariate analysis showed a relationship between failure and age under 36months (P=0.002). There were no readmissions. There were unscheduled consultations in 3% of cases: for minor otorrhagia in 5 cases and uncomplicated otorrhea in 2.
Conclusion:
Major otologic surgery in children is compatible with day-surgery. Younger patients, usually candidates for cochlear implantation, had greater risk of crossover to conventional admission. In this age group, scheduling should be earlier in the morning, with rigorous postoperative nausea and vomiting prophylaxis.
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