Temporal Trends and Regionalization of Acute Mastoiditis Management in the United States.
Otol Neurotol 2021;
42:733-739. [PMID:
33481546 DOI:
10.1097/mao.0000000000003050]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE
To describe demographics and to analyze temporal trends in the inpatient management of acute mastoiditis admissions.
STUDY DESIGN
Cross-sectional analysis.
SETTING
National Inpatient Sample, 2002-2014.
PATIENTS
26,072 nonelective inpatient admissions with primary diagnosis of acute mastoiditis.
INTERVENTION
Myringotomy, mastoidectomy, or no procedure.
MAIN OUTCOME MEASURES
We described the patient- and hospital-level demographics of acute mastoiditis admissions and the frequency of complications. We evaluated the percentage of patients requiring surgical management. Binary logistic regression was performed to determine whether there was a significant increase in the percentage of patients treated at academic institutions.
RESULTS
The majority of patients were ≤40 years old (64.9%) and Elixhauser comorbidity index ≥4 (57.4%); 23.3% (SE 0.8%) presented with complications associated with acute mastoiditis, the most common of which was a subperiosteal abscess (11.5%, SE 0.7%). Among all admissions, 30.9% (SE 1.1%) underwent myringotomy, 13.8% (SE 0.8%) required both myringotomy and mastoidectomy. On multivariate analysis, there was a statistically significant increase in the percentage of mastoiditis admissions to teaching hospitals for all admissions (OR 1.55 [CI 1.22-1.97], p < 0.001) and even more evident for cases with associated complications (OR 1.85 [CI 1.21-2.83], p = 0.004).
CONCLUSIONS AND RELEVANCE
A sizeable percentage of patients with acute mastoiditis present with complications which may require surgical intervention. From 2002 to 2014, inpatient care of acute mastoiditis became increasingly regionalized to teaching hospitals, suggestive of increased specialization within certain facilities. This trend may have significant impacts on the cost and subsequent quality of care provided to these patients.
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