Applicability of contemporary quality indicators in vestibular surgery—do they accurately measure tumor inherent postoperative complications of vestibular schwannomas?

Abstract

Background Due to rising costs in health care delivery, reimbursement decisions have progressively been based on quality measures. Such quality indicators have been developed for neurosurgical procedures, collectively. We aimed to evaluate their applicability in patients that underwent surgery for vestibular schwannoma and to identify potential new disease-specific quality indicators. Methods One hundred and three patients operated due to vestibular schwannoma were subject to analysis. The primary outcomes of interest were 30-day and 90-day reoperation, readmission, mortality, nosocomial infection and surgical site infection (SSI) rates, postoperative cerebral spinal fluid (CSF) leak, facial, and hearing function. The secondary aim was the identification of prognostic factors for the mentioned primary outcomes. Results Thirty-day (90-days) outcomes in terms of reoperation were 10.7% (14.6%), readmission 9.7% (13.6%), mortality 1% (1%), nosocomial infection 5.8%, and SSI 1% (1%). A 30- versus 90-day outcome in terms of CSF leak were 6.8% vs. 10.7%, new facial nerve palsy 16.5% vs. 6.1%. Hearing impairment from serviceable to non-serviceable hearing was 6.8% at both 30- and 90-day outcome. The degree of tumor extension has a significant impact on reoperation (p < 0.001), infection (p = 0.015), postoperative hemorrhage (p < 0.001), and postoperative hearing loss (p = 0.026). Conclusions Our data demonstrate the importance of entity-specific quality measurements being applied even after 30 days. We identified the occurrence of a CSF leak within 90 days postoperatively, new persistent facial nerve palsy still present 90 days postoperatively, and persisting postoperative hearing impairment to non-serviceable hearing as potential new quality measurement variables for patients undergoing surgery for vestibular schwannoma.

Quality indicators and early adverse in surgery for atypical meningiomas: A 16-year single centre study and systematic review of the literature

“…Applicability, usefulness and limitations of the classical quality indicators (30-day readmission, reoperation, nosocomial- and surgical site infection rate, mortality rate and length of stay), and the need for adequate risk adjustment strategies have been extensively discussed before ( Spille et al., 2022 ; Schipmann et al., 2016 , 2017 , 2019a , 2019b , 2020 , 2022 ; Dasenbrock et al., 2018 ).…”

“…For that purpose, the implementation of standardized quality indicators has become a central issue in many medical fields, including neurosurgery. Currently suggested quality indicators are 30-day readmission, reoperation and mortality rates, length of stay (LOS), rates of nosocomial infections and surgical site infection (SSI) ( Spille et al., 2022 ; Schipmann et al., 2017 , 2019a , 2019b , 2020 , 2022 ; Dasenbrock et al., 2018 ). Postoperative complications after cranial neurosurgery are closely connected to the mentioned quality indicators ( Schipmann et al., 2019a ).…”