Safety of middle-ear day-surgery in children: A STROBE observational study

Abstract

ObjectiveThe main objective of this pediatric study of otologic surgery was to analyze factors for success of outpatient management. The secondary objective was to study unscheduled postoperative consultations and readmissions. Materials and methodsThis retrospective observational study analyzed clinical characteristics and procedures in consecutive children undergoing major ear surgery over a 3-year period in a teaching hospital. The study followed STROBE recommendations. ResultsWe included 214 day-cases from a total population of 271 children. Median age was 109±44months (9years) [range: 8–196months (16years)]. In 57% of cases, the procedure was performed without mastoidectomy: 84 myringoplasties and 37 tympanoplasties. In 43% of cases, mastoidectomy was associated: 47 cochlear implants and 46 closed tympanoplasties for cholesteatoma. Ninety-five percent of day-surgeries were successful; in 5%, there was crossover to pediatric ENT department admission, for the following symptoms: postoperative nausea and vomiting in 3 cases, pain in 3, and late awakening in 5. Univariate analysis showed a relationship between failure and age under 36months (P=0.002). There were no readmissions. There were unscheduled consultations in 3% of cases: for minor otorrhagia in 5 cases and uncomplicated otorrhea in 2. ConclusionMajor otologic surgery in children is compatible with day-surgery. Younger patients, usually candidates for cochlear implantation, had greater risk of crossover to conventional admission. In this age group, scheduling should be earlier in the morning, with rigorous postoperative nausea and vomiting prophylaxis.