Safety and Perioperative Complications in Pediatric Otologic Surgery

Abstract

Objectives:

There is a paucity of data regarding postoperative complications associated with pediatric otologic procedures. We describe safety and postoperative sequelae of these procedures using data from the largest quality improvement initiative in pediatric surgery, the American College of Surgeons National Surgery Quality Improvement Program-Pediatric (NSQIP-P). This study is the first to assess safety of pediatric otologic surgery using NSQIP-P data.

Methods:

We identified children who underwent outpatient otologic surgery using current procedural terminology codes. Variables of interest included patient demographics and 30-day unplanned postoperative events including reoperation, readmission, and wound complication. Adverse event rates were determined and prevalence of events was compared by procedure type and within patient subgroups.

Results:

Of 37,319 pediatric surgical cases, 2410 were otologic procedures. The most common procedure was tympanoplasty (N = 836, 34.7%), followed by myringoplasty (N = 741, 30.7%), tympanomastoidectomy (N = 630, 26.1%), and cochlear implantation (N = 464, 19.3%). There were 7 reoperations (0.3%), 30 readmissions (1.2%), and 17 wound complications (0.6%). Cochlear implantation had the highest readmission and reoperation rates (12/464, 2.6% and 3/464, 0.7%) of the procedures studied, followed by tympanomastoidectomy (8/630, 1.3% and 3/630, 0.5%). There was not enough power to determine statistical significance of patient characteristics that increased risk of adverse event.

Conclusions:

Pediatric otologic procedures are commonly performed and have extremely low rates of postoperative 30-day complications. Although NSQIP-P is a powerful, nationally recognized quality platform, optimization is necessary for assessment of meaningful procedure-specific outcomes in pediatric otologic surgery. Analysis of pooled NSQIP-P data across future years may guide determination of predictive factors for an adverse event.