National Trends in Vestibular Schwannoma Surgery: Influence of Patient Characteristics on Outcomes

Abstract

Objective 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.

Short-Term Surgical Outcome for Vestibular Schwannoma in Sweden: A Nation-Wide Registry Study

“…The baseline characteristics in our material show a mean age of 50.6 years at diagnosis and this is comparable to the most recent surgical register-based publication (26), while lower than the average of 58 years reported from a register-based study in Denmark (18) although the Danish study also included patients with wait-and-scan regimen and this may explain the difference in age. Given the estimated incidence of a little more than 6/100.000 per year in Sweden, where the population increased from just above 9 million to approximately 9.8 million during the seven-year study period (Statistics Sweden: www.scb.se), surgery appears to be the main treatment modality (21).…”

“…In terms of complication frequency, it is difficult to compare our results to those of others, since the definition of an “complication” is not uniform, nor is the registration once the patient has been discharged. For instance, while the infection frequency of 10% reported by the SBTR is high compared to the 0.2% reported by Hatch et al (26), the 0.2% represent surgical site infections only, not including urinary tract infection, pneumonia, sepsis etc., demonstrating the need for standardized variables across studies. Similarly, in SBTR postoperative hematoma was registered in 3.2% of patients, which is considerably higher than the 1.2% recently reported by others (26).…”

“…For instance, while the infection frequency of 10% reported by the SBTR is high compared to the 0.2% reported by Hatch et al (26), the 0.2% represent surgical site infections only, not including urinary tract infection, pneumonia, sepsis etc., demonstrating the need for standardized variables across studies. Similarly, in SBTR postoperative hematoma was registered in 3.2% of patients, which is considerably higher than the 1.2% recently reported by others (26). The definition and screening for postoperative hematoma is not uniform and it is unclear if the reported number represents a true difference in complication frequency, but this could be a topic for improving quality in Sweden.…”

“…Register-based results on outcome after VS surgery have been published previously, albeit most reports are older and may not be representative for the current treatment practice (25). Another limitation for the generalizability of previous results is that some are based on non-consecutive and non-population-based material (i.e., patients only treated in selected academic centers) (26–29). Finally, the SBTR is a generic brain tumor registry and we report on the surgical outcome in more general terms, while some of the earlier registry studies have primarily focused on functional outcome such as hearing preservation and/or facial nerve function (18).…”

“…It has been observed that male VS patients have larger tumors and a higher incidence of hearing loss at presentation compared to female VS patients (30). It has also been noted there is a larger number of females than males receiving surgical treatment (26). In our material 50.4% of patients with small tumors were female, but for patients with larger tumors (≥ 4 cm) only 31%, ( p = 0.02) were female.…”