Time of cochlear implant surgery in academic settings
Received 23 June 2009; received in revised form 1 September 2009; accepted 19 October 2009.
Abstract
Objective
Establish the time required to perform cochlear implantation (CI) in academic settings.
Study Design
Historical cohort study.
Setting
German and American academic centers.
Patients
A total of 2639 patients underwent CI (1997-2007). We excluded patients receiving an experimental device or technique and those with abnormal cochlear anatomy or incomplete charts, leaving 2253 for analysis.
Intervention
Unilateral, bilateral, and revision CI with devices approved in the U.S. and Europe.
Main Outcome Measures
Mean surgical time (ST) and total operating room time (TORT).
Results
Mixed model analysis was used; estimated marginal means were calculated in minutes after adjusting for random effect of individual surgeon. There were no differences between unilateral (ST = 171, TORT = 245) and revision CI (ST = 160, TORT = 232), but bilateral procedures were longer (ST = 295, TORT = 377, P < 0.001). In unilateral surgeries, Cochlear Limited (CL) devices were implanted faster (ST = 165, TORT = 225) than Advanced Bionics (ABC) (ST = 183, P = 0.001; TORT = 240, P = 0.023) or MedEl (ST = 193, P < 0.001; TORT = 253, P = 0.002) devices. There were no differences for unilateral CI between ABC and MedEl devices. For revision CI, ABC devices (ST = 141, TORT = 219) were implanted faster than CL devices (ST = 181, P = 0.001; TORT = 266, P < 0.001). There were no differences by age group or between Germany and the U.S. ST and TORT were shorter for 575 CIs performed in the final two years of the study (unilateral CI: ST = 145, TORT = 209; bilateral CI: ST = 259, TORT = 330; revision CI: ST = 138, TORT = 205). For unilateral CI, ST and TORT decreased yearly (linear regression, P < 0.001) and inversely correlated with surgeon experience (linear regression, P < 0.01).
Conclusions
We report the time required to perform CI in academic settings—data that are vital for cost-benefit analyses and assessing new CI techniques.
aDepartment of Otolaryngology, Medical University of Hannover, Hannover, Germany
bDepartment of Otolaryngology–Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
cDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
Corresponding author: Robert F. Labadie, MD, PhD, Department of Otolaryngology–Head & Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, 7209 Medical Center East, Nashville, TN 37232-8605
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
ABSTRACT