Risk Factors for 30-Day Non-Neurological Morbidity and Cerebrospinal Fluid Leak in Patients Undergoing Surgery for Vestibular Schwannoma

Abstract

Introduction We analyzed perioperative risk factors for morbidity and mortality for the patients undergoing surgical intervention for vestibular schwannoma along with rates of cerebrospinal fluid (CSF) leaks that required surgery. Materials and Methods Patients undergoing surgery vestibular schwannoma were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2016 using current procedural terminology (CPT) codes for posterior fossa surgical approaches and International Classification of Diseases 9th revision (ICD 9) and ICD 10 codes for peripheral nerve sheath tumor. Preoperative laboratories, comorbidities, and operative times were analyzed along with CSF leaks and unplanned returns to the operating room. Results Nine-hundred ninety-three patients fit the inclusion criteria. Average age was 51, 41% were male, and 58% were female. Mortality within 30 days of the operation was very low at 0.4%, complications were 7% with infection being the most common at 2.3%, and unplanned reoperations happened in 7.4% of the cases. Dependent functional status (odds ratio [OR]: 5.7, 95% confidence interval [CI]: 1.9–16.6, p = 0.001), preoperative anemia (OR: 2.4, 95% CI: 1.2–4.5, p = 0.009), and operative time over 8 hours (OR: 1.9, 95% CI: 1.1–3.4, p = 0.017) were the only significant predictors of perioperative complications. CSF leak postoperatively occurred in 37 patients (3.7%). Reoperation for CSF leak was necessary in 56.3% of the cases. Operative time over 8 hours was the only independent significant predictor of postoperative CSF leak (OR: 2.2, 95% CI: 1.1–4.3, p = 0.028). Conclusion Dependent functional status preoperatively, preoperative anemia, and duration of surgery over 8 hours are the greatest predictors of complications in the 30-day postoperative period.

Incidence and Long-Term Health Care Utilization Associated With Pseudomeningocele Repair Following Vestibular Schwannoma Resection: A National Database Analysis

“…Our study highlights the economic implications of CSF leak following VS surgery over the long term. Our results are concordant with another national database study which reported a 3.7% incidence of CSF leak following VS resection and 56.3% required surgical repair for CSF leak [3].…”

“…Cerebrospinal fluid (CSF) leak following vestibular schwannoma (VS) surgery can occur in up to 13% of patients [1][2][3]. Types of surgical approaches [(translabyrinthine, TL up to 13%), (middle fossa, MF and retrosigmoid, RS up to 10.6% each)] have not been shown to have an impact on the incidence of CSF leak [1,2,4].…”

“…Types of surgical approaches [(translabyrinthine, TL up to 13%), (middle fossa, MF and retrosigmoid, RS up to 10.6% each)] have not been shown to have an impact on the incidence of CSF leak [1,2,4]. However, other studies have reported obesity and longer operative time (>eight hours) as risk factors for CSF leak following VS surgery [3,5].…”

“…CSF leak and pseudomeningocele (PSM) following VS resection results in significant morbidity with a higher incidence of meningitis and increased utilization of health care resources [1,6]. A recent study using the American College of Surgeons National Surgical Quality (NSQIP) from 2012 to 2016 reported that CSF leak was noted in 3.7% of patients (n=37/993) and of these, 56.3% required surgical repair for CSF leak [3].…”

Endoscopic Endonasal Eustachian Tube Obliteration for Cerebrospinal Fluid Rhinorrhea: A Case Series and Scoping Review

“…Various factors have been inconsistently associated with increased CSF leak risk after lateral skull base surgery—BMI, male gender, tumor size, functional status, combined approaches, or length of surgery. 10,22-27 Most of the patients in our scoping review were female—in both failed and revision subsets. BMI was only reported in our retrospective series and averaged 23.9 kg/m 2 (SD ± 4.9).…”