The developed predictive model for preoperative estimation of CI operative duration is a useful instrument for improving operating room management and customizing care plans in various CI practice environments.
Abstract
Objective The study aimed to develop a predictive model for preoperative estimation of CI operative duration by identifying independent clinical and procedural factors that significantly influence surgical time. Design Single-centre retrospective observational study. Settings King Abdullah Ear Specialist Center (KAESC). Participants A total of 216 cochlear implant patients were enrolled between 2019 and 2025. Main outcome measures The primary outcome was surgical time (minutes), defined as the duration from skin incision to wound closure. Secondary measures included demographic, clinical, and intraoperative factors evaluated as predictors of surgical duration. Statistical analysis was performed using SPSS version 26 and R version 4.2.2. Univariate and multivariate generalized linear models were used to identify independent predictors of surgical time and develop a final predictive model. Results Surgical time was longer in females (180 vs. 150 min, p = 0.015), bilateral (190 min, p < 0.00001) and primary/revision cases (240 min, p = 0.003), and surgeries involving fellows or residents (p < 0.00001), whereas the round window approach (p = 0.036) and sealing the insertion route (p = 0.025) were associated with shorter times. In multivariate analysis, male gender was associated with a reduction in time by 16.6 min with CI 95% (−0.36, −32.77) (p = 0.0464), unilateral implantation by 62 min (p < 0.00001), and the round window technique by 28.5 min (p = 0.0445), while older age was associated with an increase in time by 0.13 min (p = 0.0034). A Consultant/Fellow/Resident team added 43 min (p = 0.0090). Conclusion The developed predictive model is a useful instrument for improving operating room management and customizing care plans in various CI practice environments.
Purpose To determine the anatomical and visual outcomes of macular hole surgery and identify factors associated with surgical success among patients at Kilimanjaro Christian Medical Centre (KCMC) and Comprehensive Community-Based Rehabilitation Hospital (CCBRT), Tanzania. Methods We conducted a retrospective cohort study between August and December 2023. Data on demographics, pre- and postoperative clinical characteristics, surgical details, and outcomes were extracted from medical records using a structured data collection tool. Analyses were performed using SPSS version 27. The Friedman test was used to compare median pre- and postoperative visual acuity (VA). Generalized estimating equations with logistic regression assessed factors associated with macular hole closure, while gamma regression modelled postoperative logMAR VA, accounting for repeated measures. Statistical significance was set at p < 0.05. Ethical approval was obtained from the Institutional Review Board, and patient data were handled confidentially. Results A total of 101 eyes were analysed, of which all had idiopathic macular holes. Preoperatively, the median logMAR VA was 1.2(Snellen 6/96). At three months, median VA improved to 1.00(Snellen 6/60), representing a gain of 0.20 logMAR (approximately two ETDRS lines; p < 0.001). Anatomical closure was achieved in 70% of eyes. Multivariable analysis showed that good preoperative VA increased the odds of macula hole closure (aOR 19.77; 95% CI 1.20–25.3; p = 0.037). The use of the conventional ILM flap technique was associated with an increase in logMAR VA (aβ = 0.05, 95% CI 0.01–0.08, p = 0.012). Anatomical closure correlated with significant visual improvement (p < 0.001). Effect sizes for VA changes were modest, reflecting limited but meaningful functional gain. Conclusion Over two-thirds of eyes achieved anatomical closure with modest visual improvement. These findings confirm the effectiveness of macular hole surgery in resource-limited settings. Expanding surgical capacity and applying evidence-based techniques could further improve outcomes. Longer-term follow-up with optical coherence tomography is recommended to optimize treatment strategies and patient counselling.
Surgeon seniority was not a significant determinant of surgically induced astigmatism after phacoemulsification cataract surgery, and machine-learning models based on preoperative clinical data provided only limited predictive value, particularly for vector astigmatism outcomes.
Denizcan Özizmirliler, C. Engin, Ö. Özkan et al.· BMC Ophthalmology· 0 citations
Objectives: The aim of this study was to compare the surgical and postoperative clinical outcomes of punch-only and linear incision techniques for implantation of the Ponto® bone conduction implant. Methods: Surgical and follow-up data were collected from 101 patients: 46 treated with Minimally Invasive Ponto® Surgery (MIPS) and 55 with the linear incision technique (LT). The analysis focused on: (1) the surgical procedure, including operative time and intraoperative complications; (2) the healing process; and (3) long-term implant-site outcomes, including implant loss. Results: Median operative time was significantly shorter for MIPS than for LT (30 min vs. 40 min, p < 0.001). No major intraoperative complications were observed in either group. Adverse skin reactions were more frequent in the LT group than in the MIPS group (18.2% vs. 8.7%), but the difference was not statistically significant (p = 0.249). A single implant loss occurred in the LT group 18 months after surgery and was unrelated to failed osseointegration or the surgical technique, being caused by recurrent cholesteatoma. Conclusions: MIPS was associated with a significantly shorter operative time than the LT. Both MIPS and LT appear to be safe techniques. No statistically significant differences were detected between the groups with respect to adverse skin reactions or implant survival during the follow-up period.
Paulina Podlawska-Nowak, Wojciech Gawęcki, Anna Bartochowska· Journal of Clinical Medicine· 0 citations
Abstract Background Postoperative complications following middle ear surgery present ongoing challenges despite advances in surgical techniques. A comprehensive analysis of complication patterns, associated risk factors, and their interactions with patient comorbidities is needed to improve patient safety and outcomes. Objectives To analyze the incidence, patterns, and risk factors of postoperative complications following middle ear surgery, and to develop a predictive model for complication risk assessment incorporating patient demographics, comorbid conditions, surgical variables, and surgeon experience. Material and Methods This single-center retrospective cohort study analyzed 200 patients who underwent middle ear surgery between January 2018 and December 2024. Data were collected on demographics (including body mass index and smoking status), comorbidities (hypertension, diabetes mellitus), preoperative conditions, surgical procedures, surgeon experience, and postoperative complications. Risk factors were identified using univariate and multivariate logistic regression analyses. Severity of facial nerve palsy was graded using the House-Brackmann scale, and sensorineural hearing loss was classified as mild, moderate, or severe. Results A total of 45 patients (22.5%) experienced at least one postoperative complication, yielding 53 complication events (eight patients experienced multiple complications). Early complications (<30 days) occurred in 33 patients (16.5%) and late complications (≥30 days) in 12 patients (6.0%). The most common complications were sensorineural hearing loss (8.5%; mild in 9, moderate in 5, severe in 3), facial nerve paresis (4.5%; all delayed onset; House-Brackmann Grade II in 4, Grade III in 3, Grade IV in 2), surgical site infection (4.0%), and CSF leak (2.5%). Multivariate analysis identified cholesteatoma (OR = 3.24, 95% CI: 1.68–6.25, p < 0.001), surgical duration >180 min (OR = 2.87, 95% CI: 1.42–5.79, p = 0.003), revision surgery (OR = 2.45, 95% CI: 1.23–4.88, p = 0.011), and age ≥60 years (OR = 2.12, 95% CI: 1.08–4.17, p = 0.029) as independent risk factors. Body mass index, smoking status, and comorbidities (hypertension, diabetes mellitus) were analyzed but did not reach statistical significance in multivariate analysis. Surgeon experience (≤5 years) was associated with higher complication rates on univariate analysis (31.8% vs. 17.9%, p = 0.028) but was not retained in the final multivariate model. The predictive model showed good discrimination (AUC = 0.812, 95% CI: 0.751–0.873) with an events-per-variable ratio of 11.25. Conclusions and Significance Postoperative complications remain significant in middle ear surgery, with cholesteatoma, prolonged surgery, revision procedures, and advanced age as key risk factors. The developed predictive model can aid in preoperative risk stratification and guide enhanced perioperative monitoring for high-risk patients, potentially improving surgical safety and outcomes.
Yunfan Yin, Ling Ji, Yan-Rui Wang et al.· Acta Oto-Laryngologica· 0 citations
BACKGROUND
Combined procedures are common in plastic surgery, but risk is framed by operative time rather than by the number and burden of additional procedures.
METHODS
We analyzed American College of Surgeons National Surgical Quality Improvement Program plastic surgery cases from 2014 to 2023. Stacking burden was 0, 1, 2, or ≥3 additional Current Procedural Terminology-coded procedures. Multivariable logistic regression was used to evaluate 30-day wound complications, reoperation, readmission, and medical complications, adjusting for patient factors, operative time, primary-procedure work relative value units (wRVUs), and procedure family. Moreover, absolute risk differences, wRVU-weighted burden, and operative-time interaction were evaluated.
RESULTS
Among 286,295 cases, 160,098 (55.9%) included ≥1 additional procedure. Compared with none, ≥3 additional procedures were associated with wound complications (odds ratio 1.12, 95% confidence interval 1.07-1.18), reoperation (1.54, 1.46-1.63), readmission (1.41, 1.33-1.50), and medical complications (1.31, 1.21-1.42). Adjusted absolute increases were 0.51, 1.48, 1.01, and 0.40% points (numbers needed to harm, 195, 67, 99, and 251; ΔAUC 0.000-0.005). Weighted burden remained associated with all outcomes (odds ratios 1.04-1.09 per 10 wRVUs). Absolute increases were greatest in operations that lasted ≥240 min (wound complications 1.76, reoperation 2.54, and readmission 1.90% points). Cross-family stacking was associated with wound complications and readmission.
CONCLUSIONS
Procedural stacking is associated with higher 30-day morbidity independent of operative time and primary-procedure wRVUs, and it was most strongly associated for reoperation and readmission and during prolonged operations. The number and breadth of additional procedures, although they did not improve discrimination, provide preoperative information that should be weighed alongside expected duration in combined operations.
Miracle Uzoekwe, Shaan Sekhon, C. Tompkins-Rhoades et al.· Journal of Plastic, Reconstr...· 0 citations
The findings suggest that tumor characteristics may play a substantial role in determining outcomes; however, the observational design does not allow independent assessment of the causal effect of the surgical approach.
L. Bonosi, U.E. Benigno, G. Giammalva et al.· Skull Base· 0 citations
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