Risk Factors for Surgical Site Infections in Pediatric Otologic Surgery

Introduction: Surgical site infections (SSIs) in children undergoing otologic procedures cause morbidity. Identification of SSI risk factors may improve outcomes.

Methods: A retrospective case-control study was conducted utilizing the American College of Surgeons-National Surgical Quality Improvement Program Pediatric Database. Patients under 18 years who underwent tympanoplasty or cochlear implant from 2017 to 2021 were included. Patient comorbidities were analyzed, including weight under 10 kilograms (kg), age under one year, American Society of Anesthesiology (ASA) class, wound class, and history of wound infection, cardiac disease, chronic lung disease, neuromuscular disorder, cerebral palsy, or cardiac surgery. Incidence of SSI, including superficial incisional, deep incisional, and organ/space infection, as well as wound dehiscence and reoperation were evaluated. A multivariate logistic regression analysis was performed to identify associations between patient comorbidities and wound complications. Odds ratios (ORs) were reported with 95% confidence intervals (CIs).

Results: Of the 2,768 patients included in the study, 727 underwent cochlear implantation and 2,041 underwent tympanoplasty. Total SSIs reported were 23. Of them, 12 patients experienced wound dehiscence. Multivariate analysis indicated independent predictors of SSI were weight less than 10kg (OR = 4.65, 95% CI = 1.52 to 14.27, p = 0.002), chronic lung disease (OR = 5.85, 95% CI = 1.46 to 23.4, p = 0.012), cerebral palsy (OR = 9.02, 95% CI = 2.27 to 35.8, p = 0.002), and ASA Class two (OR = 2.87, 95% CI = 1.11 to 7.41, p = 0.03). Independent predictors of any wound complication, dehiscence, or reoperation included weight under 10kg (OR = 5.20, 95% CI = 2.20 to 12.32, p < 0.001), contaminated wound (OR = 2.49, 95% CI = 1.01 to 6.12, p = 0.047), and neuromuscular disorder (OR = 4.63, 95% CI = 1.81 to 11.82, p = 0.001).

Conclusions: Pediatric patients undergoing tympanoplasty or cochlear implant who are under 10kg, have chronic lung disease, or who have a neuromuscular disorder are more likely to experience postoperative wound complications, including SSI.