Trends in the incidence and treatment of mastoiditis and associated complications

Abstract

Problem: Evaluating hospital utilization for incidence and treatment of mastoiditis. Methods: Records of the National Inpatient Sample (NIS) were searched for diagnosis of mastoiditis and examined for demographics, complications, and procedures. Data were analyzed to identify factors affecting length of stay (LOS) and charges. Results: There were 2,289 (0.01% of NIS) admissions for mastoiditis (1,272 pediatric and 1,017 adult cases). The mastoiditis group had a lower mean age and higher percentages of males and Hispanics than the NIS population. The principal diagnosis of mastoiditis was divided into acute/subacute (54.7%), chronic (24.0%), mastoiditis (12.7%), with abscess (5.0%), and with complications (3.6%). About 22% of both pediatric and adult populations experienced complications associated with mastoiditis. Pediatric cases with complications had a higher age and more secondary diagnoses (p<0.001) whereas adults with complications had increased secondary diagnoses. Pediatric cases had an average of 1.2 procedures (predominantly myringotomy) and adults had an average of 1.4 procedures (primarily mastoidectomy). Cases with complications had increased LOS ( P < 0.01) but similar charges to cases without complications. Pediatric acute/subacute admissions had fewer secondary diagnoses and procedures ( P < 0.001) and decreased LOS and charges ( P < 0.02) than chronic cases. LOS was shorter in the adult chronic cases with procedural treatment ( P < 0.05). Acute/subacute cases had fewer procedures and increased LOS (both P < 0.001). Conclusion: Hospital treatment of mastoiditis remains medical for acute/subacute disease and procedural for chronic disease in all ages. Myringotomy is the predominant procedural treatment in pediatrics whereas mastoidectomy is preferred in adults. Increased age and secondary diagnoses is associated with complications from mastoiditis in pediatrics. Increased secondary diagnoses are associated with complications in adults. Multiple factors including timing of disease, age, race, and secondary diagnoses affect LOS and total charges. Significance: Determining current standard of practice in the treatment of mastoiditis in an effort to improve treatment outcomes. Support: None reported.