Influence of Sociodemographic and Clinical Factors on Follow-up Adherence and Outcomes Following Bone-anchored Hearing Implantation

Objective: To evaluate the relationship between sociodemographic and clinical factors and follow-up rates and outcomes after Osseointegrated Steady-State Implant (OSIA) implantation. Design: Retrospective cohort study. Setting: Tertiary care center. Patients: Individuals who underwent OSIA implantation at Northwell Health from September 24, 2020 to October 14, 2024. Intervention: Independent variables included race, language, insurance, income, hearing loss etiology and type, incision type, device model, and history of otologic surgery. Main outcomes: Dependent variables were audiologic and otologic follow-up adherence, time to surgery, time to activation (TTA), device use, surgical complications, and audiometric outcomes. Providers were also surveyed regarding perceived sociodemographic barriers to follow-up. Results: Fifty-nine patients (71 ears) were included. Patients from low-income areas had shorter time to surgery (9.2 vs. 24.2 mo, P = 0.044) but required more replacement parts (66.7% vs. 18.9%, P = 0.024). Medicaid-insured patients had longer TTA (59.6 vs. 43.8 d, P = 0.032). No other socioeconomic differences were significant. Congenital hearing loss correlated with fewer otology follow-ups (1.83 vs. 3.41, P = 0.0022), and conductive loss with more missed appointments (0.40 vs. 0.07, P = 0.026). Horizontal incisions were associated with fewer otologic follow-ups (1.89 vs. 3.74, P = 0.0023) and fewer replacements (13.9% vs. 39.1%, P = 0.033). OSI300 devices were activated sooner (43.3 vs. 56.9 d, P = 0.041) and required fewer otologic and audiologic follow-ups. Among 7 providers, 43% cited socioeconomic status, language, and insurance as barriers to follow-up; 14% cited race. Conclusions: Surgical timing, follow-up, and postoperative outcomes following OSIA implantation were driven primarily by clinical factors; among sociodemographic variables, only insurance type was associated with prolonged TTA. Provider perceptions overestimated the impact of sociodemographic factors.