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Surgical Outcomes of Acute Mastoiditis in Pediatric Patients: A Pediatric Health Information System Study
Shachi Srivatsa1,2, Brenna Rachwal2, Taha Akbar2
1Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Insights
Surgical approach and disease severity impact pediatric acute mastoiditis outcomes. More complex procedures like mastoidectomy alone or myringotomy with mastoidectomy were linked to longer hospital stays and higher readmission rates.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Health Informatics
Background:
- Acute mastoiditis (AM) is a significant pediatric concern.
- Surgical interventions are common for AM, but outcomes vary.
- Understanding treatment impacts is crucial for pediatric care.
Purpose of the Study:
- To evaluate outcomes of surgically treated acute mastoiditis (AM) in pediatric patients.
- To compare outcomes based on different surgical approaches: mastoidectomy alone, myringotomy with mastoidectomy (MMT), and myringotomy alone.
- To identify factors influencing length of stay and readmission rates.
Main Methods:
- Retrospective cohort study utilizing the Pediatric Health Information System (PHIS).
- Included children aged 0-18 years with AM treated between 2016-2022.
- Analyzed outcomes including length of stay (LOS) and 90-day all-cause readmission, adjusting for complications and patient/hospital variables.
Main Results:
- Among 1368 patients, 46.6% had myringotomy alone, 11.2% mastoidectomy alone, and 42.3% MMT.
- Complicated AM was prevalent (62.3%), particularly in mastoidectomy groups (76.5%-77.9%).
- Mastoidectomy alone and MMT were associated with significantly longer LOS and higher 90-day readmission rates compared to myringotomy alone.
Conclusions:
- Surgical approach and disease severity are key determinants of pediatric AM outcomes.
- Findings support the use of validated administrative data for studying AM.
- This research addresses limitations in prior literature on pediatric AM surgical outcomes.
Objective:
To evaluate outcomes of surgically treated acute mastoiditis (AM) in pediatric patients using the Pediatric Health Information System (PHIS).
Study Design:
Retrospective cohort study.
Setting:
Pediatric tertiary care centers participating in the PHIS.
Methods:
Children aged 0 to 18 years with AM treated from January 1, 2016, to December 31, 2022, were identified using International Classification of Diseases, Tenth Revision, Clinical Modifications (ICD-10) codes and categorized by surgical treatment: mastoidectomy alone, myringotomy with mastoidectomy (MMT), or myringotomy alone. Primary outcomes were length of stay (LOS) and 90-day all-cause readmission. Complicated AM was defined via diagnosis codes indicating disease extension beyond the middle ear/mastoid. Multivariable regression models adjusting for patient and hospital-level variables assessed associations. Cohort validation was performed through chart review.
Results:
Among 1368 patients, 637 (46.6%) underwent myringotomy alone, 153 (11.2%) mastoidectomy alone, and 578 (42.3%) MMT. Complicated AM was present in 62.3%, most frequently in patients receiving mastoidectomy alone (76.5%) or MMT (77.9%). Median LOS was longer in the mastoidectomy group (5 days) compared to MMT (4 days) and myringotomy alone (3 days; P < .0001). In adjusted models, mastoidectomy (incident rate ratio [IRR]: 1.20, 95% CI: 1.07-1.34) and MMT (IRR: 1.10, 95% CI: 1.02-1.18) were associated with longer LOS. Ninety-day readmissions occurred in 9.3% of patients, highest in the mastoidectomy group (14.4%; P = .027). Intensive care unit (ICU) admission (adjusted odds ratio [aOR]: 3.98, 95% CI: 2.34-6.77), hematologic/immunologic conditions (aOR: 3.17, 95% CI: 1.85-5.43), and malignancy (aOR: 7.94, 95% CI: 3.91-16.12) were predictors of readmission.
Conclusion:
This multi-institutional study shows that surgical approach and disease severity correlate with pediatric AM outcomes. Findings support using validated administrative data in studying AM outcomes, addressing limitations of prior literature.
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