title: Factors associated with prolonged duration of post-tympanoplasty local treatment in adult chronic otitis media patients: A retrospective observational study using a Japanese inpatient database.
abstract: OBJECTIVE
  The occurrence of persistent infection following tympanoplasty has been reported in many studies, and it is important to know the risks for site infection after tympanoplasty. In this study, we aimed to explore the factors affecting early wound complications after tympanoplasty for chronic otitis media.
  
  
  METHODS
  We conducted a retrospective cohort study using the Diagnosis Procedure Combination database. Data on a total of 13,094 adult patients from 420 acute-care hospitals who received tympanoplasty for chronic otitis media from 2010 to 2013 were extracted. The duration (days) of postsurgical local wound treatment was measured as an outcome, because this duration was assumed to be prolonged by the existence of wound infection. The associations between treatment duration and background characteristics (age, sex, body mass index, smoking status, diabetes mellitus, use of antithrombotic agents, with or without cholesteatoma, duration of anesthesia, academic hospital or not, and hospital volume) were assessed by multivariable linear regression analyses, fitted with a generalized estimating equation to adjust for within-hospital clustering.
  
  
  RESULTS
  The median treatment duration in each hospital was 8 days (interquartile range: 7-11). Factors significantly associated with longer treatment duration were: older age (0.2 days for 10-year increase), use of antithrombotic agents during hospitalization (1.8 days), and prolonged duration of anesthesia (vs. <120min of anesthesia, additional 1, 2, 3, and 4 days for 120-179, 180-239, 240-299, and ≥300min of anesthesia, respectively). Body mass index and smoking status were not significantly associated with treatment duration.
  
  
  CONCLUSIONS
  Older age, antithrombotic agents during hospitalization, and longer anesthesia time were independently associated with early local wound complications after tympanoplasty for chronic otitis media.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 1130033, Japan. Electronic address: sayasuzuki-tky@umin.ac.jp.
authors.forename: Sayaka
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo 1130033, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo 1130033, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo 1130034, Japan.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 1130033, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamasoba
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000706:statistics & numerical data; D002908:Chronic Disease; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007564:Japan; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D010033:Otitis Media / Q000601:surgery*; D011182:Postoperative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000628:therapy*; D013997:Time Factors; D014433:Tympanoplasty; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents
keywords: Chronic otitis media; Early complications; Local wound treatment; Tympanoplasty