Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Laryngoscope. 2012 Dec;122(12):2824-31. doi: 10.1002/lary.23605. Epub 2012 Aug 14.
OBJECTIVES/HYPOTHESIS: Lower cranial nerve injury may be an under-reported complication of vestibular schwannoma surgery. This study aims to characterize the prevalence of complications associated with vagus nerve injury following vestibular schwannoma surgery and the impact of these complications on patient care.
Retrospective cross-sectional study.
Discharge data from the Nationwide Inpatient Sample for 17,281 patients with vestibular schwannoma who underwent surgery in 2003-2008 were analyzed using cross-tabulations and multivariate regression modeling.
Dysphagia was reported in 443 cases (2.6%) and unilateral vocal fold paralysis in 115 cases (0.7%). The mean length of hospitalization was 5.3 days (95% confidence interval [CI], 4.9-5.7) and was prolonged in patients with dysphagia (mean, 11.7 days; 95% CI, 8.9-14.4) and in those with unilateral vocal fold paralysis (mean, 12.1 days; 95% CI, 7.3-16.9). Compared to patients without dysphagia, a diagnosis of dysphagia was associated with advanced comorbidity status (37.0% vs. 18.8%), central nervous system complications (39.3% vs. 15.3%), aspiration pneumonia (7.1% vs. 0.4%), and greater likelihood of requiring medical care at another facility or at home after discharge (48.5% vs. 6.6%, P < .001). Tracheostomy (3.4% vs. 0.8%) and gastrostomy tube placement (20.9% vs. 0.5%) were significantly more likely in patients with dysphagia (P < .0001). After adjusting for other variables, dysphagia, aspiration pneumonia, and tracheostomy were significantly associated with increased length of hospitalization and hospital-related costs.
Although infrequently reported in this national inpatient sample, vagus nerve injury-related symptoms are associated with significantly increased length of hospitalization and costs of care.
目的/假设：颅神经损伤可能是前庭神经鞘瘤手术中报告不足的并发症。本研究旨在描述与前庭神经鞘瘤手术后迷走神经损伤相关的并发症的发生率，并评估这些并发症对患者护理的影响。
回顾性横断面研究。
使用交叉表和多变量回归模型分析了 2003 年至 2008 年期间在全国住院患者样本中接受手术治疗的 17281 例前庭神经鞘瘤患者的出院数据。
报告吞咽困难 443 例（2.6%），单侧声带麻痹 115 例（0.7%）。平均住院时间为 5.3 天（95%置信区间[CI]，4.9-5.7），吞咽困难患者的住院时间延长（平均 11.7 天；95%CI，8.9-14.4），单侧声带麻痹患者的住院时间延长（平均 12.1 天；95%CI，7.3-16.9）。与无吞咽困难的患者相比，吞咽困难的诊断与更严重的合并症状态（37.0%比 18.8%）、中枢神经系统并发症（39.3%比 15.3%）、吸入性肺炎（7.1%比 0.4%）以及更有可能在出院后需要在其他医疗机构或家中接受医疗护理（48.5%比 6.6%，P<0.001）相关。与无吞咽困难的患者相比，气管切开术（3.4%比 0.8%）和胃造口管放置术（20.9%比 0.5%）更常见（P<0.0001）。在校正其他变量后，吞咽困难、吸入性肺炎和气管切开术与住院时间延长和医疗费用增加显著相关。
尽管在这个全国住院患者样本中报告的频率较低，但迷走神经损伤相关症状与显著的住院时间延长和医疗费用增加相关。
