Ambulatory vs. in-patient stapedectomy: a randomized twenty-patient pilot study

Admission Rates Following Day-Case Major Otologic Surgery: A Systematic Review

OBJECTIVE

To assess whether day-case major otologic ear surgery is a safe and feasible alternative to inpatient surgery, while maintaining equal complication rates, and to identify causes of admission after day-case surgery.

DATA SOURCES

PubMed, Embase, and Cochrane.

REVIEW METHODS

A systematic search was conducted. Studies reporting original data on the effect of day-case ear surgery on admission rate, patient satisfaction, and/or postoperative complications were included. Risk of bias of the selected articles was assessed using criteria based on the Cochrane Collaboration's tool for assessing risk of bias.

RESULTS

A total of 1,734 unique studies were retrieved of which 35 articles discussing 34 studies were eligible for data extraction. The admission rates ranged from 0% to 88% following day-case endaural surgery, 0% to 13% following day-case stapes surgery, 0% to 82% following day-case mastoid surgery, and 0% to 15% following day-case cochlear implant surgery. Patient and parent satisfaction regarding day-case surgery ranged from 67% to 99%. Five studies comparing day-case and inpatient otologic surgery showed no difference in hearing outcome, postoperative complications, or patient satisfaction.

CONCLUSION

The highest pooled admission rate was seen following day-case mastoid surgery. Studies comparing day-case and inpatient care suggest hearing results and postoperative complication rates in day-case otologic surgery are similar to inpatient otologic surgery in both children and adults. Therefore, day-case major otologic surgery seems to be a safe and feasible alternative to inpatient surgery for both children and adults.

Day-case stapes surgery: Day-case versus inpatient stapes surgery for otosclerosis: a randomized controlled trial

BACKGROUND

Otosclerosis is characterized by bony deposits in the otic capsule, resulting in stapes fixation and progressive hearing loss. It can be treated effectively by surgically removing (part of) the stapes and replacing it with a prosthesis. Increasingly, stapes surgery is performed as a day-case procedure. The major drive towards day-case surgery has been out of economic considerations. However, it is also increasingly an explicit patient request and leads to shorter waiting times for surgery, a reduced risk of infection and most likely positively influences the patient's quality of life as a result of rapid discharge and rehabilitation. Even though stapes surgery seems well suited to a day-case approach, given the low complication rates and early recovery, evidence is scarce and of low quality.

METHODS AND DESIGN

A single-center unblinded randomized controlled trial was designed to (primarily) investigate the effect of hearing outcomes of day-case stapes surgery compared to inpatient stapes surgery and (secondarily) investigate the effect of both methods on quality of life, tinnitus, vertigo and cost-effectiveness. One hundred and twelve adult otosclerosis patients who are eligible for stapes surgery will be randomly assigned to either the day-case or inpatient treatment group. The primary and secondary outcome measures will be assessed using pure-tone audiometry (at approximately 2 months and 1 year follow-up), questionnaires (at 3 months and 1 year follow-up) and costs diaries (weekly the first month after which once a month until 1 year follow-up).

DISCUSSION/CONCLUSION

This trial allows for a comparison between day-case and inpatient stapes surgery to investigate the hypothesis that day-case stapes surgery is associated with a higher quality of life and higher cost-effectiveness, while maintaining equal hearing results, compared to inpatient stapes surgery.

TRIAL REGISTRATION

Netherlands Trial Register (www.trialregister.nl): NTR4133, registration date 21(st) August 2013.

Is Small-Fenestra Stapedotomy a Safer Outpatient Procedure than Total Stapedectomy?

We compared two stapedoplasty techniques to evaluate whether one technique is safer than the other as an outpatient procedure and to demonstrate possible reasons for outpatient failures. We performed a retrospective study of patient records of 94 operated adult patients who were all initially scheduled for outpatient surgery for otosclerosis (47 total stapedectomies and 47 small-fenestra stapedotomies). Six patients (13%) with stapedectomy and 1 patient (2%) with stapedotomy had to stay overnight at the hospital due to postoperative vertigo and nausea. The number of outpatient failures was statistically significantly different between the stapedoplasty techniques (p = 0.05). Five patients (11%) with stapedectomy and 2 patients (4%) with stapedotomy had a drop in bone conduction threshold between 5 and 8 dB pre- to postoperatively (n.s.). The short-term hearing improvement did not differ statistically significantly between the techniques when compared to the preoperative values. Small-fenestra stapedotomy is the safer procedure to be performed as outpatient setting than total stapedectomy.

Estapedectomía como cirugía ambulatoria

Day case surgery is increasing and a large proportion of procedures in otolaryngology are already being performed as day cases. There is less experience in otologic surgery and the reports are specially referred to chronic otitis media. A retrospective study of stapedectomy as a day-case procedure is presented in this report. The inclusion criteria: anaesthesic risk: ASA I, II or III; if the patient has a chronic disease it must be well controlled; they must not have postoperative hemorrhagic history; the patient must be accompanied by an adult the first 24 hours postsurgery; must have a vehicle; distance to hospital must not be more than an hour and they must have a telephone. Between October 1998 and December 2002 71 ambulatory stapedectomies were performed in our institution. 91.2% were discharged home the same day of the procedure. Audiological findings obtained six months after surgery that: 87.5% of the patients have an air-bone Uda of 10 dB or less.