Surgical Outcomes of Acute Mastoiditis in Pediatric Patients: A Pediatric Health Information System Study.

Abstract

To evaluate outcomes of surgically treated acute mastoiditis (AM) in pediatric patients using the Pediatric Health Information System (PHIS). Retrospective cohort study. Pediatric tertiary care centers participating in the PHIS. Children aged 0 to 18 years with AM treated from January 1, 2016, to December 31, 2022, were identified using International Classification of Diseases, Tenth Revision, Clinical Modifications (ICD-10) codes and categorized by surgical treatment: mastoidectomy alone, myringotomy with mastoidectomy (MMT), or myringotomy alone. Primary outcomes were length of stay (LOS) and 90-day all-cause readmission. Complicated AM was defined via diagnosis codes indicating disease extension beyond the middle ear/mastoid. Multivariable regression models adjusting for patient and hospital-level variables assessed associations. Cohort validation was performed through chart review. Among 1368 patients, 637 (46.6%) underwent myringotomy alone, 153 (11.2%) mastoidectomy alone, and 578 (42.3%) MMT. Complicated AM was present in 62.3%, most frequently in patients receiving mastoidectomy alone (76.5%) or MMT (77.9%). Median LOS was longer in the mastoidectomy group (5 days) compared to MMT (4 days) and myringotomy alone (3 days; P < .0001). In adjusted models, mastoidectomy (incident rate ratio [IRR]: 1.20, 95% CI: 1.07-1.34) and MMT (IRR: 1.10, 95% CI: 1.02-1.18) were associated with longer LOS. Ninety-day readmissions occurred in 9.3% of patients, highest in the mastoidectomy group (14.4%; P = .027). Intensive care unit (ICU) admission (adjusted odds ratio [aOR]: 3.98, 95% CI: 2.34-6.77), hematologic/immunologic conditions (aOR: 3.17, 95% CI: 1.85-5.43), and malignancy (aOR: 7.94, 95% CI: 3.91-16.12) were predictors of readmission. This multi-institutional study shows that surgical approach and disease severity correlate with pediatric AM outcomes. Findings support using validated administrative data in studying AM outcomes, addressing limitations of prior literature.