Department of Neurological Surgery, Boston University School of Medicine, 88 East Newton Street, Robinson 4, Boston, MA 02118, USA.
Neuro Oncol. 2011 Nov;13(11):1252-9. doi: 10.1093/neuonc/nor118. Epub 2011 Aug 19.
Acoustic neuromas present a challenging problem, with the major treatment modalities involving operative excision, stereotactic radiosurgery, observation, and fractionated stereotactic radiotherapy. The morbidity/mortality following excision may differ by patient race. To address this concern, the morbidity of acoustic neuroma excision was assessed on a nationwide level. The Nationwide Inpatient Sample from 1994-2003 was used for analysis. Only patients admitted for acoustic neuroma excision were included (International Classification of Diseases, 9th edition, Clinical Modification = 225.1; primary procedure code = 04.01). Analysis was adjusted for several variables, including patient age, race, sex, primary payer for care, income in ZIP code of residence, surgeon caseload, and hospital caseload. Multivariate analyses revealed that postoperative mortality following acoustic neuroma excision was 0.5%, with adverse discharge disposition of 6.1%. The odds ratio for mortality in African Americans compared with Caucasians was 8.82 (95% confidence interval = 1.85-41.9, P = .006). Patients with high-caseload surgeons (more than 2 excisions/year), private insurance, and younger age had decreased mortality, better discharge disposition, and lower overall morbidity (P < .04). Neither hospital caseload nor median income were predictive factors. African Americans were 9 times more likely to die following surgery than Caucasians over a decade-long analysis. Given the relatively benign natural history of acoustic neuroma and the alarmingly increased mortality rate following surgical excision among older patients, African Americans, and patients receiving care from low-caseload surgeons, acoustic neuromas in these patient populations may be best managed by a more minimally invasive modality such as observation, fractionated stereotactic radiotherapy, or stereotactic radiosurgery.
听神经瘤是一个具有挑战性的问题，主要的治疗方法包括手术切除、立体定向放射外科、观察和分次立体定向放射治疗。切除后的发病率/死亡率可能因患者种族而异。为了解决这一问题，对全国范围内听神经瘤切除的发病率进行了评估。本研究使用了 1994 年至 2003 年全国住院患者样本进行分析。仅纳入因听神经瘤切除而住院的患者（国际疾病分类，第 9 版，临床修正版=225.1；主要手术代码=04.01）。分析调整了多个变量，包括患者年龄、种族、性别、医疗费用的主要支付方、居住地邮政编码的收入、外科医生的手术量和医院的手术量。多变量分析显示，听神经瘤切除术后的死亡率为 0.5%，不良出院处置率为 6.1%。与白人相比，非裔美国人的死亡率比值比为 8.82（95%置信区间=1.85-41.9，P=0.006）。高手术量外科医生（每年切除手术超过 2 例）、私人保险和年轻患者的死亡率降低、出院处置更好、总发病率更低（P<0.04）。医院的手术量和中位数收入均不是预测因素。在长达 10 年的分析中，非裔美国人术后死亡的风险比白人高 9 倍。鉴于听神经瘤的良性自然病史以及老年患者、非裔美国人和接受低手术量外科医生治疗的患者在手术切除后死亡率显著增加，这些患者人群中的听神经瘤可能最好通过观察、分次立体定向放射治疗或立体定向放射外科等微创方式来治疗。
