Age Is Only Independent Risk Factor in Malignant Otitis Externa Patient Admission-Level Outcomes

What are the independent risk factors for 30-day readmission, prolonged lengths of stay (PLOS), and discharge to a rehabilitation facility for patients with malignant otitis externa (MOE)?

Bottom line: In patients with MOE, sociodemographic, treatment-related, and hospital-level factors were independently associated with readmission, PLOS, and discharges to a rehabilitation facility; only age was an independent risk factor for a complicated course.

BACKGROUND: Largely affecting elderly diabetics and immunocompromised patients, MOE is a temporal bone infection characterized by severe otalgia, otorrhea, and external ear canal edema refractory to topical treatment. There are no MOE standard diagnostic criteria, and information regarding national patterns in hospitalization, readmission, and length of stay is lacking.

STUDY DESIGN: Retrospective cohort study.

SETTING: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, N.Y.

SYNOPSIS: Researchers mined the Nationwide Readmission Database (NRD) to identify patients with a primary diagnosis of MOE who were hospitalized in the U.S. from 2013–2014. The resulting cohort had 1,267 hospitalizations for MOE, with 1,108 index admissions and an unplanned readmission rate of 12.5%. Diabetics made up 59.9% of the population, the elderly (age >65 years) 38.1%, and elderly diabetics 29.1%. A small portion of the cohort was immunosuppressed. Older age was shown to be a risk factor for having a complicated course and discharge to a rehabilitation facility. Although diabetes did not portend a complicated course or admission-level outcomes, it was associated with undergoing a procedure, cranial neuropathies, and other complications. Immunosuppressed patients were more likely to develop systemic sepsis as a complication. Authors concluded that in patients with MOE, sociodemographic, treatment-related, and hospital-level factors were independently associated with readmission, PLOS, and discharge to a rehabilitation facility. Limitations included coding irregularities and inaccuracies inherent with any large national dataset, potential selection bias in analyzing only inpatients, and possible underestimation in national tracking of patient readmissions.

CITATION: Schwam ZG, Ferrandino R, Kaul VZ, et al. Thirty-day readmission and prolonged length of stay in malignant otitis externa. Laryngoscope. 2020;130-2220-2228.