Tympanoplasty success based on surgeon and patient-reported outcomes perspectives : a 10-year review in a tertiary center

Abstract

BACKGROUND : The latest international trends in healthcare put more emphasis on patients’ perspectives in reporting success in surgical procedures. A holistic approach in measuring surgical outcomes, defined as global success, should include the patient’s perioperative experiences, expectations, and outcome measures. In published literature, surgeons propose several definitions of post-operative successful surgical outcomes following tympanoplasty. Most surgical outcomes and the surgeon’s definition of success exclude the patient’s perspectives. Patient-reported outcomes would allow surgeons to understand and measure the benefit of the several procedures performed from the perspective of the patients. Current definitions of successful tympanoplasty do not capture patient reported outcomes which are important to patients. A divergence is frequently found between outcomes relevant to the patient and to the surgeon. Patient-reported outcomes would complement traditionally measured clinical outcomes by the surgeon to give a true global outcome measuring success. The main aim of the current study was to propose a definition of true global success following tympanoplasty by combining the patient’s and the surgeon’s reported satisfaction rate based on the indication and the goals for the operation. RESULTS : A total of 128 procedures were performed on128 ears in 125 patients, of which 52% (n = 57) were done on the right and 48% (n = 61) on the left side. There was no significant difference between the two groups (p = 0.07). There was a female preponderance, with 62% females and 44% males (p = 0.105). The majority of patients, 63% (n = 68), were between the age of 26 and 45 years, while 19% (n = 20) fell into the 46- to 60-year age range, with no significant difference between the groups (p = 0.21). There was complete graft take in 77% (107/128) of the ears in whereas 23% (21/128) of the ears the graft had not taken at the 6-month follow-up period. The true global success satisfaction rate was 92% (chi-square test = 119; p = 0.001) compared to the 77% surgical success. CONCLUSION : In assessing success in tympanoplasty, the patient- and surgeon-reported outcomes, when considered against agreed goals and indications, correlate well statistically. In this cohort, the true global success satisfaction rate was 92% (chi-square test = 119; p = 0.001 < 0.05) compared to 77% surgical success, based on graft take only. The combination of patient- and surgeon-reported outcomes would be beneficial in reporting true global success in tympanoplasty.