Therapeutic Mastoidectomy Does Not Increase Postoperative Complications in the Management of the Chronic Ear.

Abstract

OBJECTIVE:

Tympanoplasty with or without concurrent therapeutic mastoidectomy is a controversial topic in the management of chronic ear disease. We sought to describe whether there is a significant difference in postoperative complications.

STUDY DESIGN:

Retrospective cohort study.

SETTING:

American College of Surgeons National Surgical Quality Improvement Program public files.

PATIENTS:

Current procedural terminology codes were used to identify patients with chronic ear disease undergoing tympanoplasty ± concurrent mastoidectomy in the 2011 to 14 American College of Surgeons National Surgical Quality Improvement Program files.

INTERVENTION:

Therapeutic.

MAIN OUTCOME MEASURES:

Variables were compared with χ, Fischer's exact, and Mann-Whitney U tests, as appropriate to analyze postoperative complications between tympanoplasty with or without concurrent mastoidectomy. To account for confounding factors, presence of a complication was analyzed in binary logistic regression. Analysis considered sex, hypertension, obesity, advanced age, diabetes, smoking status, American Society of Anesthesiologists Physical status, procedure.

RESULTS:

There were 4,087 patients identified meeting criteria (tympanoplasty = 2,798, tympanomastoidectomy = 1,289). There was no statistical difference in postoperative complications (tympanoplasty n = 49 [1. 8%], tympanomastoidectomy n = 33 [2. 6%]; p = 0. 087) or return to the operating room (tympanoplasty = 4 [0. 1%], tympanomastoidectomy = 6 [0. 5%]; p = 0. 082). Binary logistic regression demonstrated smoking as a predictor of a postoperative complication (OR: 1. 758, 95% CI: 1. 084-2. 851; p = 0. 022), while concurrent mastoidectomy did not significantly increase the risk of complication (OR: 1. 440, 95% CI: 0. 915-2. 268; p = 0. 115). There was a significant difference in mean operative time between tympanoplasty and tympanomastoidectomy: 85.7 versus 154.23 min, p < 0. 001.

CONCLUSION:

In the management of chronic ear disease, tympanoplasty with concurrent mastoidectomy increases time under anesthesia, but it is not associated with any increased postoperative complications compared with tympanoplasty alone.

• Authors: Matthew A Shew, Thomas Muelleman, Mark Villwock, Robert J Muelleman, Kevin Sykes, Hinrich Staecker, James L Lin
• Journal: Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (Otol Neurotol) Vol. 39 Issue 1 Pg. 54-58 (01 2018) ISSN: 1537-4505 [Electronic] United States
• PMID: 29076928 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Chronic Disease
• Cohort Studies
• Ear Diseases (surgery)
• Female
• Humans
• Male
• Mastoidectomy (methods)
• Middle Aged
• Postoperative Complications (epidemiology)
• Retrospective Studies
• Treatment Outcome
• Tympanoplasty (methods)