Obesity Is Not Associated With Postoperative Complications After Vestibular Schwannoma Surgery in a Large Single Institution Series

Lipschitz, Noga; Kohlberg, Gavriel D.; Walters, Zoe A.; Tawfik, Kareem O.; Samy, Ravi N.; Pensak, Myles L.; Zuccarello, Mario; Andaluz, Norberto; DiNapoli, Vincent; Breen, Joseph T.

doi:10.1097/mao.0000000000002397

Cited by 10 publications

(23 citation statements)

References 24 publications

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“…[11][12][13] A recent institutional study by Lipschitz and colleagues demonstrated that obesity was not a risk factor for most post-operative complications. 22 Similar to that study, we found increased BMI to be associated with post-operative cardiovascular complications, which is in-line with previous studies acknowledging obesity as a risk factor for MI. 23 Though our observed association between obesity and wound infections or severe obesity and DVT are not in-line with Lipschitz et al, 22 these finding resembles other similar findings in the surgical literature.…”

Section: Discussionsupporting

confidence: 92%

“…22 Similar to that study, we found increased BMI to be associated with post-operative cardiovascular complications, which is in-line with previous studies acknowledging obesity as a risk factor for MI. 23 Though our observed association between obesity and wound infections or severe obesity and DVT are not in-line with Lipschitz et al, 22 these finding resembles other similar findings in the surgical literature. [24][25][26] This manuscript further strengthens their conclusion by demonstrating similar rates of LOS, readmission, reoperation, pulmonary embolism, pneumonia, urinary tract infection, and septic shock rates, which were not evaluated by Lipschitz and colleagues.…”

Section: Discussionsupporting

confidence: 92%

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The association of age, body mass index, and frailty with vestibular schwannoma surgical morbidity

Goshtasbi

Abouzari

Soltanzadeh-Zarandi

et al. 2020

Clinical Neurology and Neurosurgery

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Objective: To evaluate whether increased body mass index (BMI), age, or frailty influence vestibular schwannoma (VS) short-term surgical morbidity. Methods:The 2005-2017 National Surgical Quality Improvement Program database was queried for patients with VS undergoing surgical resection. Age was stratified according to age <50, 50-64, and ≥65, while BMI was stratified based on a threshold of 30. Frailty score (0-5) was indicated based on functional status, diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension.Results: A total of 1405 patients were included consisting of 56.7% females with a mean age of 50.7±13.8 years and mean BMI of 29.4±6.6. Patients <50 (n=604), 50-64 (n=578), and ≥65 (n=223), had different duration of surgery (428±173 vs. 392±149 vs. 387±154 minutes; p<0.001) and 30-day mortality rates (0.7% vs. 0% vs. 1.8%; p=0.01). However, post-operative length of stay (LOS) (p=0.16), readmission (p=0.08), reoperation (p=0.54), and complication rates were similar. Post-operative myocardial infarction (p=0.03) and wound infection (p=0.02) were more commonly observed in the obese cohort (BMI≥30) but readmission (p=0.18), reoperation (p=0.44), and complication rates were similar to those with BMI<30. Severely obese patients (BMI≥35) also had higher rates of deep vein thrombosis (p=0.004). Frailty score 0 (n=921), 1 (n=375), and 2-4

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

The association of age, body mass index, and frailty with vestibular schwannoma surgical morbidity

Goshtasbi

Abouzari

Soltanzadeh-Zarandi

et al. 2020

Clinical Neurology and Neurosurgery

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“…As expected, we observed that discharge to a care facility and LOS were positively associated with short-term adverse events. BMI did not influence morbidity following transcervical surgery, resembling the findings of Crippen et al 29 and Lipschitz et al 31 in head and neck free flap and vestibular schwannoma surgeries, respectively. Similar to the literature concerning a wide variety of surgical fields, 16,25,32,33 this study demonstrated that smoking, with an OR of 2.1 on multivariate analysis, was predictive of short-term adverse events.…”

Section: Discussionsupporting

confidence: 82%

Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

Goshtasbi

Verma

2020

Ann Otol Rhinol Laryngol

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Objective: To describe rates of short-term morbidity following transcervical surgical treatment of hypopharyngeal diverticulum (HD) and analyze predictors of adverse events. Methods: The 2005 to 2017 National Surgical Quality Improvement Program database was queried to identify patients diagnosed with HD undergoing open transcervical diverticulectomy. Results: A total of 597 patients with a mean age of 71.4 ± 12.3 years were included. Thirty-day adverse events were experienced by 63 (10.6%) subjects, including 6.5% unplanned reoperations, 4.2% surgical complications, 4.4% medical complications, 2.7% readmissions, and 0.7% deaths. Medical complications notably included pneumonia (2.0%), reintubation (1.2%), sepsis (1.2%), intubation >48 hours (0.5%), urinary tract infection (0.5%), or deep vein thrombosis (0.5%), while surgical complications included organ/space infection (2.0%) and superficial (1.3%) or deep (1.0%) surgical site infection. Gender, race, functional status, diabetes, dyspnea, hypertension, steroid use, and recent weight loss were not associated with adverse events. Length of operation and hospitalization were both higher among those with adverse events (127.4 ± 107.9 vs 95.7 ± 59.8 minutes, P = 0.027, and 7.4 ± 7.4 vs 2.8 ± 3.6 days, P < 0.001). On multivariable logistic regression, high American Society of Anesthesiologists (ASA) class (OR = 2.02, P = 0.017), smoking (OR = 2.10, P = 0.044), and operation time (OR = 1.01; P = 0.005) were independent predictors of adverse events. Obesity was not associated with length of stay, readmission/reoperation, or complications. However, increased age was associated with shorter operations ( P = 0.020), higher length of hospitalization ( P < 0.001), and higher mortality ( P = 0.027) and readmission rates ( P = 0.023). Conclusion: Understanding clinical factors associated with complications following open surgery for HD such as ASA score, smoking status, length of operation, and age can help optimize surgical outcomes for at-risk patients. Level of Evidence: NA

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“…BMI did, however, show a negative association with good postoperative FN outcomes, although not at latest follow-up. Previous literature on effects of BMI vary, with some studies showing no association of obesity with complications 58 and with others showing an association with an increased rate of complication, 57 a longer hospital stay, 59 and development of postoperative cerebrospinal fluid leaks. 60 To our knowledge, there has not been a study directly examining the association of BMI with FN outcomes following surgery for VS.…”

Section: Predictive Factors Of Fn Functional Outcomesmentioning

confidence: 99%

Clinical Predictors of Facial Nerve Outcomes After Surgical Resection of Vestibular Schwannoma

Ren

MacDonald

Tawfik

et al. 2020

Otolaryngol.--head neck surg.

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Objective To identify clinical predictors of facial nerve (FN) outcomes after microsurgical resection of vestibular schwannoma (VS). Study Design Prospective cohort study. Setting Academic medical center. Methods Consecutive patients undergoing VS resection from November 2017 to October 2019 were included. FN function was evaluated with the House-Brackmann (HB) scale and stratified into good (HB I-II) and poor (HB III-VI) function. Analyses included descriptive statistics, correlation, and logistic regression. Results Of 256 patients who met criteria (mean age, 47.7 years; 62.5% female), 227 (88.7%) achieved good FN function postoperatively and 238 (93.0%) at latest follow-up (mean, 154.8 days). Operative approaches consisted of translabyrinthine (50.8%), retrosigmoid (25.0%), and middle fossa craniotomies (24.2%). Extent of resection was decided intraoperatively, and gross or near total resection was accomplished in 237 (92.6%) cases. Postoperative HB grade correlated with latest HB grade (0.615, P < .001). Factors associated with good postoperative FN function included small tumor size (≤15 mm; odds ratio [OR], 2.425; P = .042), gross or near total resection (OR, 3.170; P = .041), and ≥100-µV intraoperative FN electromyographic response to a 0.05-mA stimulus (OR, 22.242; P < .001). Factors associated with good FN function at latest follow-up included gross total resection (OR, 7.764; P = .003) and ≥100-µV FN electromyographic response (OR, 8.518; P < .001), accounting for surgical approach and tumor size. Conclusion Microsurgical resection of VS can be accomplished with excellent FN outcomes. Gross total resection and ≥100-µV intraoperative FN electromyographic response predicted excellent FN outcomes. Immediate postoperative FN function is a prognosticator of long-term FN function.

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Obesity Is Not Associated With Postoperative Complications After Vestibular Schwannoma Surgery in a Large Single Institution Series

Cited by 10 publications

References 24 publications

The association of age, body mass index, and frailty with vestibular schwannoma surgical morbidity

The association of age, body mass index, and frailty with vestibular schwannoma surgical morbidity

Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

Clinical Predictors of Facial Nerve Outcomes After Surgical Resection of Vestibular Schwannoma

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