Surgical Outcomes of Acute Mastoiditis in Pediatric Patients: A Pediatric Health Information System Study.
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OBJECTIVE: To evaluate outcomes of surgically treated acute mastoiditis (AM) in pediatric patients using the Pediatric Health Information System (PHIS). STUDY DESIGN: Retrospective cohort study. SETTING: Pediatric tertiary care centers participating in the PHIS. METHODS: 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. RESULTS: 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. CONCLUSION: 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.