Thirty‐Day Readmission and Prolonged Length of Stay in Malignant Otitis Externa

Abstract

ObjectivesTo determine independent risk factors for 30‐day readmission, prolonged length of stay (PLOS), and discharge to a rehabilitation facility for those with malignant otitis externa.MethodsRetrospective cohort study of patients hospitalized with malignant otitis externa (International Classification of Diseases, 9th edition, code 380.14) in the Nationwide Readmissions Database (2013–2014). Overall and disease‐specific complication and mortality data were analyzed using chi‐squared and multivariate analysis.ResultsThere were 1267 cases of malignant otitis externa extracted. A PLOS of ≥8 days (90th percentile) was found in 14.2% (n = 180) of patients, and 13.7% (n = 174) were discharged to a facility. Patients were readmitted within 30 days at a rate of 12.5% (n = 159). The overall rates of uncomplicated and complicated diabetes were found to be 42.1% and 17.8%, respectively. Factors independently associated with PLOS included undergoing a surgical procedure (odds ratio [OR] 2.08, P < .001), and having central nervous system complications (OR 3.21, P < .001). Independent risk factors for disposition to a facility included nutritional deficiency (OR 1.91, P = .029), PLOS (OR 4.61, P < .001), and age 65–79 years (OR 6.57, P = .001). Readmission was independently linked to PLOS (OR 3.14, P < .001). Diabetes was not an independent risk factor for any outcome.ConclusionsThirty‐day readmission, PLOS, and ultimate discharge to a rehabilitation facility were common and closely intertwined. Despite the classic association between diabetes and malignant otitis externa, diabetes was not an independent risk factor for any of our outcomes.Level of Evidence4 Laryngoscope, 130:2220–2228, 2020

Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

“…9,12 In this manuscript, after categorizing patients according to 50th and 75th age percentiles, advanced age was associated with prolonged LOS as well as higher rates of mortality and readmission, but shorter operation time. Similar positive associations between age and certain surgical outcomes have been reported in the head and neck literature, 24-26 while others have observed a lack of influence. 27,28 Furthermore, we attribute that the longer operation time may suggest more aggressive surgical approaches in the younger patients.…”

Necrotising Otitis Externa: Can treatment be de-escalated?

“…The majority had extensive comorbiditiesas measured by the Charleston comorbidity index; in particular diabetes mellitus, which was often poorly controlled; predisposing them to infection. Interestingly, despite the classical association with NOE, recent data suggests that diabetes mellitus is not an independent risk factor for 30-day readmission, prolonged length of stay, or discharge to a rehabilitation facility (7). Many patients in this series grew bacteria typical for NOE, such as P. Aeruginosa (8).…”

Emerging themes in necrotising otitis externa: a scoping review of the literature from 2011 to 2020 and recommendations for future research

“…19,20 Thirteen studies described their own diagnostic criteria, not based on existing definitions. [21][22][23][24][25][26][27][28][29][30][31][32][33] Others based patient inclusion on the diagnosis made by senior authors 34 and the International Classification of Diseases code at discharge. 12 Several authors acknowledged the lack of universally accepted diagnostic criteria, 4,35 and considered that this may account for apparent differences in incidence.…”