title: Safety and postoperative adverse events in pediatric otologic surgery: analysis of American College of Surgeons NSQIP-P 30-Day outcomes.
abstract: OBJECTIVE
  Describe safety and postoperative sequelae of pediatric otologic surgery and identify predictive factors for postoperative events.
  
  
  METHODS
  Retrospective cohort study of the American College of Surgeons National Surgery Quality Improvement Program-Pediatric (NSQIP-P) database.
  
  
  METHODS
  Data pooled from the 2012 NSQIP-P public use file (50 institutions).
  
  
  METHODS
  Current procedural terminology codes were used to identify children who underwent otologic surgery. Variables of interest included demographics and 30-day postoperative events grouped as reoperation, readmission, and complication. Event rates were determined and prevalence of events compared by procedure type and within patient subgroups according to chi-square analysis. Multivariate logistic regression evaluated predictive factors for postoperative events.
  
  
  RESULTS
  Of 37,319 pediatric operations, 2556 (6.8%) were otologic procedures. The most common procedure was tympanoplasty (n = 893, 34.9%), followed by myringoplasty (n = 741, 30.0%), cochlear implantation (n = 464, 18.2%), and tympanomastoidectomy (n = 458, 17.9%). There were 9 reoperations (0.4%), 32 readmissions (1.3%), and 18 complications (0.7%). Children undergoing tympanomastoidectomy or cochlear implantation were more likely to be readmitted irrespective of other factors (odds ratio = 5.5, P = .010; odds ratio = 3.5, P = .083). Children <3 years old were 4 times more likely to be readmitted than older children (odds ratio = 4.4, P < .001).
  
  
  CONCLUSIONS
  Pediatric otologic procedures are common and have low rates of global 30-day postoperative events. Tympanomastoidectomy and cochlear implantation have the highest risk of 30-day readmission. Young children (<3 years) are more likely to be readmitted following these procedures. Further optimization of the NSQIP-P to include specialty and procedure-specific variables is necessary to assess complete, actionable outcomes of pediatric otologic surgery, however the present study provides a foundation to build upon for safety and quality improvement initiatives in pediatric otology.
authors: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA croxbur1@jhmi.edu.
authors: Christopher R
authors: CR
authors: Roxbury
authors: Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.
authors: Jingyan
authors: J
authors: Yang
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors: Jose
authors: J
authors: Salazar
authors: Department of Otolaryngology-Head and Neck Surgery, Children's National Medical Center, Washington, DC, USA.
authors: Rahul K
authors: RK
authors: Shah
authors: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.
authors: Emily F
authors: EF
authors: Boss
mesh_terms: D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D013506:Otologic Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement / Q000458:organization & administration; D012189:Retrospective Studies
keywords: morbidity and mortality; pediatric otology; quality improvement