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An internally validated prognostic model for success in revision stapes surgery for otosclerosis
Author(s) -
Wegner Inge,
Vincent Robert,
Derks Laura S. M.,
Rauh Simone P.,
Heymans Martijn W.,
Stegeman Inge,
Grolman Wilko
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27132
Subject(s) - medicine , otosclerosis , stapes surgery , logistic regression , stapes , receiver operating characteristic , surgery , stapedectomy , retrospective cohort study , prosthesis , middle ear
Objectives/Hypothesis To develop a prediction model that can accurately predict the chance of success following revision stapes surgery in patients with recurrent or persistent otosclerosis at 2‐ to 6‐months follow‐up and to validate this model internally. Study Design A retrospective cohort study of prospectively gathered data in a tertiary referral center. Methods The associations of 11 prognostic factors with treatment success were tested in 705 cases using multivariable logistic regression analysis with backward selection. Success was defined as a mean air‐bone gap closure to 10 dB or less. The most relevant predictors were used to derive a clinical prediction rule to determine the probability of success. Internal validation by means of bootstrapping was performed. Model performance indices, including the Hosmer‐Lemeshow test, the area under the receiver operating characteristics curve (AUC), and the explained variance were calculated. Results Success was achieved in 57.7% of cases at 2‐ to 6‐months follow‐up. Certain previous surgical techniques, primary causes of failure leading up to revision stapes surgery, and positions of the prosthesis placed during revision surgery were associated with higher success percentages. The clinical prediction rule performed moderately well in the original dataset (Hosmer‐Lemeshow P = .78; AUC = 0.73; explained variance = 22%), which slightly decreased following internal validation by means of bootstrapping (AUC = 0.69; explained variance = 13%). Conclusions Our study established the importance of previous surgical technique, primary cause of failure, and type of the prosthesis placed during the revision surgery in predicting the probability of success following stapes surgery at 2‐ to 6‐months follow‐up. Level of Evidence 2b. Laryngoscope , 128:2390–2396, 2018