Retrospective analysis of postoperative complications and risk factors in middle ear surgery

Postoperative complications following middle ear surgery present ongoing challenges despite advances in surgical techniques. A comprehensive analysis of complication patterns, associated risk factors, and their interactions with patient comorbidities is needed to improve patient safety and outcomes.

To analyze the incidence, patterns, and risk factors of postoperative complications following middle ear surgery, and to develop a predictive model for complication risk assessment incorporating patient demographics, comorbid conditions, surgical variables, and surgeon experience.

This single-center retrospective cohort study analyzed 200 patients who underwent middle ear surgery between January 2018 and December 2024. Data were collected on demographics (including body mass index and smoking status), comorbidities (hypertension, diabetes mellitus), preoperative conditions, surgical procedures, surgeon experience, and postoperative complications. Risk factors were identified using univariate and multivariate logistic regression analyses. Severity of facial nerve palsy was graded using the House-Brackmann scale, and sensorineural hearing loss was classified as mild, moderate, or severe.

A total of 45 patients (22.5%) experienced at least one postoperative complication, yielding 53 complication events (eight patients experienced multiple complications). Early complications (<30 days) occurred in 33 patients (16.5%) and late complications (≥30 days) in 12 patients (6.0%). The most common complications were sensorineural hearing loss (8.5%; mild in 9, moderate in 5, severe in 3), facial nerve paresis (4.5%; all delayed onset; House-Brackmann Grade II in 4, Grade III in 3, Grade IV in 2), surgical site infection (4.0%), and CSF leak (2.5%). Multivariate analysis identified cholesteatoma (OR = 3.24, 95% CI: 1.68-6.25, p < 0.001), surgical duration >180 min (OR = 2.87, 95% CI: 1.42-5.79, p = 0.003), revision surgery (OR = 2.45, 95% CI: 1.23-4.88, p = 0.011), and age ≥60 years (OR = 2.12, 95% CI: 1.08-4.17, p = 0.029) as independent risk factors. Body mass index, smoking status, and comorbidities (hypertension, diabetes mellitus) were analyzed but did not reach statistical significance in multivariate analysis. Surgeon experience (≤5 years) was associated with higher complication rates on univariate analysis (31.8% vs. 17.9%, p = 0.028) but was not retained in the final multivariate model. The predictive model showed good discrimination (AUC = 0.812, 95% CI: 0.751-0.873) with an events-per-variable ratio of 11.25.

Postoperative complications remain significant in middle ear surgery, with cholesteatoma, prolonged surgery, revision procedures, and advanced age as key risk factors. The developed predictive model can aid in preoperative risk stratification and guide enhanced perioperative monitoring for high-risk patients, potentially improving surgical safety and outcomes.