Outcomes of tympanostomy tube insertion in the emergency department versus the operating room for acute mastoiditis in children

Background: Acute mastoiditis is a complication of acute otitis media in children that often requires surgical intervention. The increasing availability of procedural sedation in pediatric emergency departments (PED) means that some surgical procedures can be performed in the PED rather than in the operating room (OR), but the clinical outcomes of this practice remain unclear. Objective: To compare the outcomes of Tympanostomy Tube (TT) insertion for acute mastoiditis performed in the PED vs. in the OR in terms of complications, readmissions, and effectiveness. Methods: A retrospective observational study of patients aged 0–18 years diagnosed with acute mastoiditis at a tertiary medical center from 2013 to 2023 was conducted. Patients who underwent surgical interventions were categorized by treatment location (PED vs. OR). The data included demographics, laboratory findings, treatment details, and clinical outcomes. Results: Of 197 children with acute mastoiditis, 124 underwent TT insertion: 54 in the PED and 70 in the OR. Baseline demographics and clinical parameters were similar. Time to procedure was shorter in the PED group (2.49 h vs. 3.75 h; p = 0.01). No significant differences were observed in PED length of stay (4.1 h vs. 4.1 h; p = 0.94) or total length of stay (5.2 days vs. 5.3 days; p = 0.80). There were no statistically significant differences in post-operative complications, including PICU admissions (0% vs. 0%, p = 1.00), PED revisit rates (20% vs. 17%, p = 0.77), rehospitalizations (11.1% vs. 8.6%, p = 0.64), or repeat drainage procedures (7% vs. 6%, p = 0.82) No major anesthesia-related or surgical complications were observed. Conclusion: Tympanostomy tube insertion for acute mastoiditis in the PED was associated with shorter time to procedure. It was comparable in terms of safety and effectiveness to procedures performed in the OR. No differences were observed in emergency department admissions or hospital length of stay. Thus although PED-based interventions may be feasible in appropriately selected patients, their impact on overall resource utilization is likely to depend on local staffing, workflows, and departmental capacity.