Time-Adjusted Risk of Bone-Anchored Hearing Device Explantation Following Early and Recurrent Wound Complications

Objective: The objective was to examine the time-adjusted risk of explantation of bone-anchored hearing devices following wound complications after primary implantation. Study design: Retrospective cohort study at a tertiary care neurotology center. Patients: Adults 18 years or older with primary bone-anchored hearing implants from 2003 to 2025, with available audiogram and medical history. Excluded were patients with incomplete data, prior implantations, or immediate postoperative loss to follow-up. Outcomes: The primary outcome was the incidence of device explantation following early (<60 days) or recurrent (>3 episodes) wound complications. The Cox proportional hazards framework with time-dependent modeling was applied for analysis. Results: A total of 1090 surgical ears (666 female, 61.1%; 8 bilateral) underwent primary device implantation, with 127 (11.7%) undergoing explantation; median follow-up was 4.40 years (IQR: 1.66-7.98 y). Patients who underwent explantation were more likely to experience early (HR: 2.30; 95% CI: 1.53-3.45; P <0.001) and frequent (HR: 5.29; 95% CI: 3.62-7.72; P <0.001) wound complications. The cumulative incidence of device explantation at 10 years among patients with frequent wound complications was 60.6% (95% CI: 45.5%-71.5%), compared with 15.6% (95% CI: 11.9%-19.9%) among patients without such complications. After adjustment, frequent wound complications remained significantly associated with the device removal (aHR: 4.60; 95% CI: 2.82-7.51; P <0.001). Conclusions: Recurrent wound complications are associated with nearly a fivefold increase in hazard for device explantation, supporting the need for risk stratification, monitoring, and earlier intervention.