Clinical Indicators of Admission for Pediatric Cochlear Implant Procedures

Abstract

Objectives:

A minority of children undergoing cochlear implantation (CI) are admitted overnight postoperatively, but there are little data on prognostic indicators. Our goal is to review national data to identify variables associated with admission and identify effects on outcomes.

Methods:

We analyzed data from the 2012-2015 American College of Surgeons’ National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P) program use files. The CI patients were identified by CPT code. Demographics, comorbidities, anesthesia time, total operation time, 30-day complications, and 30-day readmission were compared between ambulatory and admitted patients.

Results:

A total of 2943 CI patients were included, with 17.2% of these admitted post implantation. Single variable analysis revealed multiple factors associated with admission post implantation. Multivariable analysis showed patients with asthma were 2.2 times (P < .001; odds ratio [OR] = 1.484-3.227) and those with structural central nervous system (CNS) abnormalities 2.1 times (P < .001; OR = 1.584-2.706) more likely to be admitted. Younger age (P = .002; OR = 0.995-0.999) and longer operation time (P < .001; OR = 1.003-1.006) were weak predictors. Two hundred sixteen patients lacked any factors but were still admitted. They had similar outcomes to ambulatory healthy patients.

Conclusion:

We identified factors associated with admission post-CI and higher readmission rates. Asthma and CNS abnormalities are strong predictors of admission post implantation. Forty-two percent of admitted patients lack any of these factors and have comparable outcomes to corresponding ambulatory patients.