Surgical Factors Influencing Wound Complication After Cochlear Implantation: A Systematic Review and Meta-Analysis.

OBJECTIVE To identify perioperative surgical factors associated with wound complications following cochlear implantation (CI). DATA SOURCES PubMed, Web of Science, and Cochrane databases. STUDY SELECTION Eligible studies included peer-reviewed research in English evaluating wound complications (wound infection, skin flap breakdown/dehiscence, seroma/hematoma) following CI. Studies with paired samples were included in the meta-analysis. DATA EXTRACTION Surgical factors (techniques and perioperative management) in CI and reported wound complications were examined. Level of evidence was assessed using the Oxford Centre for Evidence-based Medicine guidelines and bias was assessed using the NIH Quality Assessment Tool. DATA SYNTHESIS Twenty-six studies representing 10,214 cochlear implantations were included. The overall wound complications rate was 3.1% (range 0.03-13.9%). Eleven studies contained paired data and were used for meta-analysis regarding three different surgical factors: incision length, implant placement method, and antibiotic usage. Longer incision lengths (≥7 cm) demonstrated a higher risk of wound complications (risk ratio 2.27, p = 0.02, CI 1.16-4.43). Different implant placement techniques (suture fixation versus periosteal pocket) (p = 0.08, CI 0.92-3.69) and postoperative antibiotic regimens (postoperative use versus none) (p = 0.68, CI = 0.28-7.18) were not associated with differences in wound complication rates following CI. CONCLUSIONS Overall rate of wound complications following CI is low. Shorter incision length is associated with lower risk of wound complications. Differences in perioperative techniques and practices regarding implant placement and antibiotic use were not associated with differences in wound complication rates. Considering the low number and quality of studies, there is a need for research in CI outcomes using paired sample prospective designs and standardized reporting.