To characterize current vestibular schwannoma (VS) surgery outcomes with a nationwide database and identify factors associated with increased complications and prolonged hospital course.
Study Design
Retrospective review utilizing the University HealthSystem Consortium national inpatient database.
Setting
US academic health centers.
Subjects and Methods
Data from patients undergoing VS surgery were analyzed over a 3-year time span (October 2012 to September 2015). Surgical outcomes, such as length of stay (LOS), complications, and mortality, were analyzed on the basis of race, sex, age, and comorbidities during the 30-day postoperative period.
Results
A total of 3697 VS surgical cases were identified. The overall mortality rate was 0.38%, and the overall complication rate was 5.3%. Advanced age significantly affected intensive care unit LOS, mortality, and complications (P = .04). Comorbidities, including hypertension, obesity, and depression, also significantly increased complication rates (P = .02). Sixty-eight patients (1.8%) had a history of irradiation, and they had a significantly increased LOS (P = .03).
Conclusion
Modern VS surgery has a low mortality rate and a relatively low rate of complications. Several factors contribute to high complication rates, including age and comorbidities. These data will help providers in counseling patients on which treatment course might be best suited for them.
StangerupSECaye-ThomasenP. Epidemiology and natural history of vestibular schwannomas. Otolaryngol Clin North Am. 2012;45:257-268.
2.
WiegandDAFickelV. Acoustic neuroma—the patient’s perspective: subjective assessment of symptoms, diagnosis, therapy, and outcome in 541 patients. Laryngoscope. 1989;99:179-187.
3.
GalTJShinnJHuangB. Current epidemiology and management trends in acoustic neuroma. Otolaryngol Head Neck Surg. 2010;142:677-681.
4.
AhmedOHMahboubiHLahhamSPhamCDjalilianHR. Trends in demographics, charges, and outcomes of patients undergoing excision of sporadic vestibular schwannoma. Otolaryngol Head Neck Surg. 2014;150:266-274.
5.
TheodosopoulosPVPensakML. Contemporary management of acoustic neuromas. Laryngoscope. 2011;121:1133-1137.
6.
McRackanTRBrackmannDE. Historical perspective on evolution in management of lateral skull base tumors. Otolaryngol Clin North Am. 2015;48:397-405.
NonakaYFukushimaTWatanabeKet al. Contemporary surgical management of vestibular schwannomas: analysis of complications and lessons learned over the past decade. Neurosurgery. 2013;72(2)(suppl operative):ons103-ons115.
9.
WiseSCCarlsonMLTveitenOVet al. Surgical salvage of recurrent vestibular schwannoma following prior stereotactic radiosurgery. Laryngoscope. 2016;126:2580-2586.
10.
ZanolettiEFaccioliCMartiniA. Surgical treatment of acoustic neuroma: outcomes and indications. Rep Pract Oncol Radiother. 2016;21:395-398.
11.
ElixhauserASteinerCHarrisDRCoffeyRM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8-27.
12.
MachinisTGFountasKNDimopoulosVRobinsonJS. History of acoustic neurinoma surgery. Neurosurg Focus. 2005;18:e9.
13.
HouseWF. Surgical exposure of the internal auditory canal and its contents through the middle, cranial fossa. Laryngoscope. 1961;71:1363-1385.
14.
McClellandS3rdGuoHOkuyemiKS. Morbidity and mortality following acoustic neuroma excision in the United States: analysis of racial disparities during a decade in the radiosurgery era. Neuro Oncol. 2011;13:1252-1259.
15.
SlatteryWH3rdFrancisSHouseKC. Perioperative morbidity of acoustic neuroma surgery. Otol Neurotol. 2001;22:895-902.
16.
SluyterSGraamansKTullekenCAVan VeelenCW. Analysis of the results obtained in 120 patients with large acoustic neuromas surgically treated via the translabyrinthine-transtentorial approach. J Neurosurg. 2001;94:61-66.
17.
RevenigLMCanterDJTaylorMDet al. Too frail for surgery? Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes. J Am Coll Surg. 2013;217:665-670, e661.
18.
KuzuMATerziogluHGencVet al. Preoperative nutritional risk assessment in predicting postoperative outcome in patients undergoing major surgery. World J Surg. 2006;30:378-390.
19.
SungurtekinHSungurtekinUBalciCZencirMErdemE. The influence of nutritional status on complications after major intraabdominal surgery. J Am Coll Nutr. 2004;23:227-232.
20.
van VenrooijLMde VosRBorgmeijer-HoelenMMHaaringCde MolBA. Preoperative unintended weight loss and low body mass index in relation to complications and length of stay after cardiac surgery. Am J Clin Nutr. 2008;87:1656-1661.
21.
LiuJYBirkmeyerNJSandersJHet al;Northern New England Cardiovascular Disease Study Group. Risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass surgery. Circulation. 2000;102:2973-2977.
22.
PatelSNunoMMukherjeeDet al. Trends in surgical use and associated patient outcomes in the treatment of acoustic neuroma. World Neurosurg. 2013;80:142-147.
23.
ThombsBDSinghVAHalonenJDialloAMilnerSM. The effects of preexisting medical comorbidities on mortality and length of hospital stay in acute burn injury: evidence from a national sample of 31,338 adult patients. Ann Surg. 2007;245:629-634.
24.
GrossmanRMukherjeeDChangDCet al. Preoperative charlson comorbidity score predicts postoperative outcomes among older intracranial meningioma patients. World Neurosurg. 2011;75:279-285.
25.
JencksSFWilliamsDKKayTL. Assessing hospital-associated deaths from discharge data: the role of length of stay and comorbidities. JAMA. 1988;260:2240-2246.
26.
FleischmannKEGoldmanLYoungBLeeTH. Association between cardiac and noncardiac complications in patients undergoing noncardiac surgery: outcomes and effects on length of stay. Am J Med. 2003;115:515-520.
27.
BuceriusJGummertJFBorgerMAet al. Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg. 2003;75:472-478.
28.
LeeTHMarcantonioERMangioneCMet al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043-1049.
29.
LazarHLChipkinSRFitzgeraldCABaoYCabralHApsteinCS. Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation. 2004;109:1497-1502.
30.
KehletHWilmoreDW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183:630-641.
31.
O’ConnellBPRizkHGStevensSMNguyenSAMeyerTA. The relation between obesity and hospital length of stay after elective lateral skull base surgery: an analysis of the American College of Surgeons National Surgical Quality Improvement Program. ORL J Otorhinolaryngol Relat Spec. 2015;77:294-301.
32.
DoehnerWSchenkelJAnkerSDSpringerJAudebertHJ. Overweight and obesity are associated with improved survival, functional outcome, and stroke recurrence after acute stroke or transient ischaemic attack: observations from the TEMPiS trial. Eur Heart J. 2013;34:268-277.
33.
StevensSMO’ConnellBPMeyerTA. Obesity related complications in surgery. Curr Opin Otolaryngol Head Neck Surg. 2015;23:341-347.
34.
QuesnelAMMcKennaMJ. Current strategies in management of intracanalicular vestibular schwannoma. Curr Opin Otolaryngol Head Neck Surg. 2011;19:335-340.
35.
SmouhaEEYooMMohrKDavisRP. Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm. Laryngoscope. 2005;115:450-454.
36.
SelesnickSHJohnsonG. Radiologic surveillance of acoustic neuromas. Am J Otol. 1998;19:846-849.
37.
YamakamiIUchinoYKobayashiEYamauraA. Conservative management, gamma-knife radiosurgery, and microsurgery for acoustic neurinomas: a systematic review of outcome and risk of three therapeutic options. Neurol Res. 2003;25:682-690.
38.
HamelMBHendersonWGKhuriSFDaleyJ. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53:424-429.
39.
MaruschFKochASchmidtUet al. The impact of the risk factor “age” on the early postoperative results of surgery for colorectal carcinoma and its significance for perioperative management. World J Surg. 2005;29:1013-1021.
40.
ChuangSKPerrottDHSusarlaSMDodsonTB. Age as a risk factor for third molar surgery complications. J Oral Maxillofac Surg. 2007;65:1685-1692.
41.
HeinOVBirnbaumJWerneckeKEnglandMKonertzWSpiesC. Prolonged intensive care unit stay in cardiac surgery: risk factors and long-term-survival. Ann Thorac Surg. 2006;81:880-885.
42.
PolanczykCAMarcantonioEGoldmanLet al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med. 2001;134:637-643.
43.
IncalziRACapparellaOGemmaAet al. The interaction between age and comorbidity contributes to predicting the mortality of geriatric patients in the acute-care hospital. J Intern Med. 1997;242:291-298.
44.
FaireyAChetnerMMetcalfeJet al. Associations among age, comorbidity and clinical outcomes after radical cystectomy: results from the Alberta Urology Institute radical cystectomy database. J Urol. 2008;180:128-134.
45.
CarlsonMLMarstonAPGlasgowAEet al. Racial differences in vestibular schwannoma. Laryngoscope. 2016;126:2128-2133.
46.
BabuRSharmaRBagleyJHHatefJFriedmanAHAdamsonC. Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management. J Neurosurg. 2013;119:121-130.
FiscellaKFranksPMeldrumSBarnettS. Racial disparity in surgical complications in New York State. Ann Surg. 2005;242:151-155.
49.
MerkusPTaibahASequinoGSannaM. Less than 1% cerebrospinal fluid leakage in 1,803 translabyrinthine vestibular schwannoma surgery cases. Otol Neurotol. 2010;31:276-283.
50.
MangusBDRivasAYooMJet al. Management of CSF leaks following vestibular schwannoma surgery. Otol Neurotol. 2011;32:1525.
51.
SelesnickSHLiuJCJenANewmanJ. The incidence of cerebrospinal fluid leak after vestibular schwannoma surgery. Otol Neurotol. 2004;25:387-393.
52.
GoddardJCMeyerTNguyenSLambertPR. New considerations in the cause of spontaneous cerebrospinal fluid otorrhea. Otol Neurotol. 2010;31:940-945.
53.
O’MalleyKJCookKFPriceMDWildesKRHurdleJFAshtonCM. Measuring diagnoses: ICD code accuracy. Health Serv Res. 2005;40:1620-1639.
54.
SuttonJMHayesAJWilsonGCet al. Validation of the University HealthSystem Consortium administrative dataset: concordance and discordance with patient-level institutional data. J Surg Res. 2014;190:484-490.
