@article{AJO5173,
author = {Mark Laidlaw and Damien Khaw and Maya Reid and Sukanya Rajiv and Jean-Marc Gerard},
title = {Perioperative complication rates in elderly cochlear implant recipients—a systematic review and meta-analysis},
journal = {Australian Journal of Otolaryngology},
volume = {9},
number = {0},
year = {2026},
keywords = {},
abstract = {Background: Cochlear implantation is increasingly offered to older adults with severe-to-profound hearing loss, yet age-specific perioperative risks remain incompletely characterised. Existing reviews largely pool broad adult cohorts or provide narrative summaries of elderly recipients, limiting precise risk estimation for older candidates. This systematic review and meta-analysis aimed to quantify perioperative complication rates among cochlear implant recipients aged ≥65 years and compare these rates with those in younger adults.Methods: We conducted a PRISMA-compliant systematic review with a prospectively registered protocol (PROSPERO CRD420251207956). We searched MEDLINE, PubMed, Embase, CINAHL, Scopus, Cochrane Library, and Web of Science from inception to 18 November 2025, supplemented by citation searching. Eligible studies reported intra- or postoperative complications after cochlear implantation in adults aged ≥65 years, included ≥10 elderly recipients, and had ≥30 days’ follow-up. Random-effects meta-analyses estimated absolute complication risks in elderly cohorts (single-arm), and relative risks versus younger adults (two-arm) when possible. Analyses were stratified by age threshold (≥65, ≥70, ≥75, ≥80 years). Sensitivity analyses examined robustness through leave-one-out influence analyses and exclusion of high-risk-of-bias study sensitivity analysis.Results: Forty-one studies (6,374 elderly implant recipients and 5,904 younger comparators) contributed to meta-analyses. No perioperative mortality was reported. For major complications, the pooled incidence in elderly recipients aged ≥65 years was 2.43% [95% confidence interval (CI): 1.73–3.41%; I2=0.0%]. Minor complications occurred in 22.27% of elderly recipients (95% CI: 16.06–30.02%; I2=85.9%), and anaesthetic complications occurred in 3.08% of elderly recipients (95% CI: 2.19–4.33%; I2=31.9%). Two-arm comparisons against younger adult cohorts were suggestive of increased relative risk in the elderly of both minor surgical [risk ratio (RR) 1.64, 95% CI: 1.04–2.60, P=0.0401; I2=0.0%] and anaesthetic complications (RR 4.58, 95% CI: 1.99–10.53, P=0.0101; I2=0.0%), though these were not statistically robust to sensitivity analysis. Discharge failure occurred in 2.3% of elderly recipients. Device-related complications occurred in 4.21% of elderly recipients (95% CI: 2.99–5.91%; I2=54.3%). Persistent vertigo rates ranged from 6–8.5% across age strata, with no clear age-related trend. Falls showed possible age-related increases at thresholds ≥70 years but under-reporting is likely. GRADE Certainty of evidence ratings ranged from very low to low.Conclusions: Cochlear implantation in the elderly is associated with low absolute rates of major surgical complications and modest rates of minor, anaesthetic events. While cochlear implantation appears safe and effective for appropriately selected elderly candidates, estimates of minor surgical complication rates carry very low certainty of evidence due to substantial between-study heterogeneity. Further investigation into precipitants of minor surgical complications is required. Careful anaesthetic assessment is important in very elderly cohorts, with attention to vestibular symptoms and fall risk.},
issn = {2616-2792}, url = {https://www.theajo.com/article/view/5173}
}