Skip to main content

Advertisement

SpringerLink
Log in

Feasibility of day-case pediatric cochlear implantation

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Pediatric cochlear implantation is performed on an outpatient basis in an inconstant way. The aim of this study is to assess the feasibility of day-case pediatric cochlear implantation by determining the acceptability of outpatient-to-inpatient conversion rate (acceptability threshold of 5%) and to assess the safety by comparing outpatient and inpatient postoperative events. We also want to identify conversion predictive factors.

Methods

We conducted a monocentric retrospective study including 267 cases aged 6 months to 18 years who underwent unilateral cochlear implantation between 2016 and 2020. This population was divided into two groups: outpatient group (190 cases) and inpatient group (77 cases).

Results

Among the 190 cases scheduled as day surgery, 9 cases required conversion to conventional hospitalization which leads to an outpatient-to-inpatient conversion rate of 4.7%. Postoperative nausea and vomiting (PONV) were involved in all cases of conversion. Conversion predictive factors were the presence of an inner ear malformation at risk of gusher (OR 32.51, 95% CI [4.98–370.27], p 0.001) and the intraoperative administration of morphine (OR 8.52, 95% CI [1.38–86.84], p 0.035). There was no statistically significant difference in immediate postoperative complications (outpatient 14.2% vs inpatient 16.9% p 0.715), early-stage complications (outpatient 12.6% vs inpatient 10.4% p 0.812) and early-stage unplanned consultations (outpatient 4.7% vs inpatient 3.9% p 0.748) between outpatient and inpatient groups. Unplanned readmissions were found only in the outpatient group.

Conclusion

Day-case pediatric cochlear implantation is a feasible and safe procedure even in infants. The outpatient-to-inpatient conversion rate of 4.7% is considered acceptable but requires anticipation of human and accommodation needs. No causes of conversion were life-threatening. The risk of postoperative complications and unplanned consultations are not influenced by the mode of hospitalization. Special attention should be paid to the prevention of PONV and the presence of inner ear malformations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. HAS – ANAP (2012) Ensemble pour le développement de la chirurgie ambulatoire, socle de connaissances. https://www.has-sante.fr/jcms/c_1242334/chirurgie-ambulatoire-socle-de-connaissances. Accessed 10 Jun 2021

  2. European Association for Children in Hospital (2016) EACH charter. https://www.ukbb.ch/wAssets/docs/downloadcenter/Charta-Kinder-Spital_ENG.pdf. Accessed 27 Sep 2021

  3. François M, Geib I (2006) Chirurgie ORL ambulatoire chez l’enfant. Ann Otolaryngol Chir Cervico-Faciale 123:163–166. https://doi.org/10.1016/S0003-438X(06)76660-9

    Article  Google Scholar 

  4. Couloigner V (2015) Chirurgie ambulatoire en ORL pédiatrique (enfant de moins de 18 ans). Lett D’ORL Chir Cervico-Faciale 8–12

  5. Green Z, Woodman N, David J, McLernon DJ, Engelhardt T (2020) Incidence of paediatric unplanned day-case admissions in the UK and Ireland: a prospective multicentre observational study. Br J Anaesth 124(4):463–472. https://doi.org/10.1016/j.bja.2019.11.035

    Article  Google Scholar 

  6. Teschner M, Polite C, Lenarz T, Lustig L (2013) Cochlear Implantation in Different Health-Care Systems. Otol Neurotol 34(1):66–74. https://doi.org/10.1097/MAO.0b013e318278bf58

    Article  Google Scholar 

  7. Powell HRF, Rowlands RG, Lavy JA, Wright A (2010) Day-case pediatric middle ear surgery: From myringoplasty to bilateral cochlear implantation. Int J Pediatr Otorhinolaryngol 74:803–806. https://doi.org/10.1016/j.ijporl.2010.04.006

    Article  PubMed  Google Scholar 

  8. Liu JH, Roland PS, Waller MA (2000) Outpatient cochlear implantation in the pediatric population. Otolaryngol Neck Surg 122:19–22. https://doi.org/10.1016/S0194-5998(00)70138-0

    Article  CAS  Google Scholar 

  9. Stephens J, Cruise A, Shaida A (2010) Cochlear implants as a paediatric day surgery service. Cochlear Implants Int 11:221–224. https://doi.org/10.1179/146701010X12671177819064

    Article  PubMed  Google Scholar 

  10. Agence technique de l’information sur l’hospitalisation (2014) VISUCHIR | Stats ATIH. https://www.scansante.fr/applications/visuchir. Accessed 24 Sep 2021

  11. American society of anesthesiologists ASA physical status classification system. https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system. Accessed 20 Sep 2021

  12. Léculée R, Courrèges P (2010) Chirurgie ambulatoire de l’enfant de moins de 18 ans: recommandations CNCE/ADARPEF. Arch Pédiatrie 17:844–845. https://doi.org/10.1016/S0929-693X(10)70140-8

    Article  Google Scholar 

  13. Chung F (1995) Discharge criteria — a new trend. Can J Anaesth 42:1056–1058. https://doi.org/10.1007/BF03011083

    Article  CAS  PubMed  Google Scholar 

  14. Qureshi AA, Padgham ND, Jiang D (2006) Day-case major ear surgery: is it viable? J Laryngol Otol. https://doi.org/10.1017/S0022215105004299

    Article  PubMed  Google Scholar 

  15. Rowlands RG, Harris R, Hern J, Knight JR (2002) Major ear surgery in a paediatric day care unit. J Laryngol Otol 116:791–793. https://doi.org/10.1258/00222150260293583

    Article  CAS  PubMed  Google Scholar 

  16. Dornhoffer J, Manning L (2000) Unplanned admissions following outpatient otologic surgery: the University of Arkansas experience. Ear Nose Throat J 79(710):713–717

    Google Scholar 

  17. The royal college of anaesthetists (2020) Raising the standards: RCoA quality improvement compendium. 4th edition. https://rcoa.ac.uk/sites/default/files/documents/2020-08/21075%20RCoA%20Audit%20Recipe%20Book_Combined_Final_25.08.2020_0.pdf

  18. Sennaroğlu L, Bajin MD (2017) Classification and current management of inner ear malformations. Balk Med J 34:397–411. https://doi.org/10.4274/balkanmedj.2017.0367

    Article  Google Scholar 

  19. Kim BG, Sim NS, Kim SH et al (2013) Enlarged cochlear aqueducts: a potential route for CSF gushers in patients with enlarged vestibular aqueducts. Otol Neurotol 34:1660–1665. https://doi.org/10.1097/MAO.0b013e3182a036e4

    Article  PubMed  Google Scholar 

  20. Sivam SK, Syms CA, King SM, Perry BP (2017) Consideration for routine outpatient pediatric cochlear implantation: a retrospective chart review of immediate post-operative complications. Int J Pediatr Otorhinolaryngol 94:95–99. https://doi.org/10.1016/j.ijporl.2016.12.018

    Article  PubMed  Google Scholar 

  21. Bourdaud N, Devys J-M, Bientz J et al (2014) Development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients: the VPOP score. Pediatr Anesth 24:945–952. https://doi.org/10.1111/pan.12428

    Article  Google Scholar 

  22. Veroul E, Sabban D, Blexmann L et al (2021) Predictive factors of vertigo following cochlear implantation in adults. Eur Arch Otorhinolaryngol 278:3731–3741. https://doi.org/10.1007/s00405-020-06449-y

    Article  CAS  PubMed  Google Scholar 

  23. Li S, Qin Z, Zhang F et al (2014) Early complications following cochlear implantation in children and their management. Int J Pediatr Otorhinolaryngol 78:1040–1044. https://doi.org/10.1016/j.ijporl.2014.03.036

    Article  PubMed  Google Scholar 

  24. Loundon N, Blanchard M, Roger G et al (2010) Medical and surgical complications in pediatric cochlear implantation. Arch Otolaryngol Neck Surg 136:12. https://doi.org/10.1001/archoto.2009.187

    Article  Google Scholar 

  25. Becke K (2014) Anesthesia for ORL surgery in children. GMS Curr Top Otorhinolaryngol Head Neck Surg. https://doi.org/10.3205/CTO000107

    Article  PubMed  PubMed Central  Google Scholar 

  26. Papsin BC (2005) Cochlear implantation in children with anomalous cochleovestibular anatomy. Laryngoscope 115:1–26. https://doi.org/10.1097/00005537-200501001-00001

    Article  PubMed  Google Scholar 

  27. Loundon N, Leboulanger N, Maillet J et al (2008) Cochlear implant and inner ear malformation. Int J Pediatr Otorhinolaryngol 72:541–547. https://doi.org/10.1016/j.ijporl.2008.01.004

    Article  PubMed  Google Scholar 

  28. Loundon N, Rouillon I, Munier N et al (2005) Cochlear implantation in children with internal ear malformations. Otol Neurotol 26:668–673. https://doi.org/10.1097/01.mao.0000178126.58859.a9

    Article  CAS  PubMed  Google Scholar 

  29. Hansen S, Anthonsen K, Stangerup S-E et al (2010) Unexpected findings and surgical complications in 505 consecutive cochlear implantations: a proposal for reporting consensus. Acta Otolaryngol (Stockh) 130:540–549. https://doi.org/10.3109/00016480903358261

    Article  Google Scholar 

  30. Arnoldner C, Baumgartner WD, Gstoettner W, Hamzavi J (2005) Surgical considerations in cochlear implantation in children and adults: A review of 342 cases in Vienna. Acta Otolaryngol (Stockh) 125:228–234. https://doi.org/10.1080/00016480410022895

    Article  Google Scholar 

  31. Hasan RA, LaRouere MJ, Kartush J, Bojrab D (2004) Ambulatory tympanomastoid surgery in children: factors affecting hospital admission. Arch Otolaryngol Neck Surg 130:1158. https://doi.org/10.1001/archotol.130.10.1158

    Article  Google Scholar 

  32. Bhatia K, Gibbin KP, Nikolopoulos TP, Oonoghue GM (2004) Surgical complications and their management in a series of 300 consecutive pediatric cochlear implantations. Otol Neurotol 25:730–739. https://doi.org/10.1097/00129492-200409000-00015

    Article  PubMed  Google Scholar 

  33. Farinetti A, Ben Gharbia D, Mancini J et al (2014) Cochlear implant complications in 403 patients: Comparative study of adults and children and review of the literature. Eur Ann Otorhinolaryngol Head Neck Dis 131:177–182. https://doi.org/10.1016/j.anorl.2013.05.005

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hospices Civils de Lyon, Hôpital Edouard Herriot, Département d’oto-rhino-laryngologie, de chirurgie cervico-maxillo-faciale et d’audiophonologie, 69003, Lyon, France

    Margot Hugel, Aurélie Coudert, Eric Truy & Ruben Hermann

  2. Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d’ORL et de Chirurgie Cervico-Faciale Pédiatrique, F-69500, Bron, France

    Margot Hugel, Sonia Ayari-Khalfallah, Aurélie Coudert & Eric Truy

  3. Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’ORL, d’otoneurochirurgie et de chirurgie cervico-faciale, 69495, Pierre-Bénite, France

    Maxime Fieux

  4. Université Claude Bernard Lyon 1, 69003, Lyon, France

    Maxime Fieux, Eric Truy & Ruben Hermann

Authors
  1. Margot Hugel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sonia Ayari-Khalfallah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maxime Fieux
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aurélie Coudert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eric Truy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ruben Hermann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Margot Hugel.

Ethics declarations

Conflict of interest

None of the authors declares any conflict of interest.

Ethical approval

This study complies with the ethical and legal requirements of the French law (March 5, 2012) and the Declaration of Helsinki. Approval from the Ethics comity of the Lyon University Hospital was received for this study (no. 21_392).

Informed consent

In accordance with French law (March 5, 2012) with regards to research limited to gathering retrospective data stemming from medical files, all legal representatives were informed that they had the right to refuse that their children’ data or information be used in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hugel, M., Ayari-Khalfallah, S., Fieux, M. et al. Feasibility of day-case pediatric cochlear implantation. Eur Arch Otorhinolaryngol 279, 5123–5133 (2022). https://doi.org/10.1007/s00405-022-07353-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-022-07353-3

Keywords

Search

Navigation