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

• Published in: The Laryngoscope 2020-09, Vol.130 (9), p.2220-2228
• Main Authors: Schwam, Zachary G., Ferrandino, Rocco, Kaul, Vivian Z., Wanna, George B., Cosetti, Maura K.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Databases, Factual; Diabetes; Ear Neoplasms - pathology; Ear Neoplasms - rehabilitation; external otitis; Female; Humans; Length of Stay - statistics & numerical data; Logistic Models; Male; Malignant otitis externa; Middle Aged; necrotizing otitis externa; Odds Ratio; otitis externa; Otitis Externa - pathology; Otitis Externa - rehabilitation; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Retrospective Studies; Risk Factors; skullbase osteomyelitis; Time Factors; United States; Young Adult
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.28409

Objectives To 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. Methods Retrospective 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. Results There 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. Conclusions Thirty‐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 Evidence 4 Laryngoscope, 130:2220–2228, 2020