Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA.
Otolaryngol Head Neck Surg. 2014 Feb;150(2):275-81. doi: 10.1177/0194599813512106. Epub 2013 Nov 7.
We sought to investigate the postoperative complications of vestibular schwannoma excision and determine their significant clinical predictors.
Cross-sectional.
California Hospital Inpatient Discharge Datasets 1997-2011.
Data for vestibular schwannoma excisions performed in California were extracted using the ICD-9-CM code "04.01 excision of acoustic neuroma." Demographics, principal payer, state of residence, comorbidities, as well as hospital case volume were examined as possible predictors. Postoperative complications and patient disposition were examined as outcome variables. Comorbidities and complications were identified using ICD-9-CM diagnoses and procedures codes.
Overall, 6553 cases were examined. Comorbidities were present in 2539 (38.7%) patients. Postoperative complications occurred in 1846 (28.2%) patients; 1714 (26.2%) neurological and 337 (5.1%) medical complications. Patients' admission ended with death or further care (ie, skilled nursing facilities) in 260 (4.0%) cases. Mortality rate was 0.2%. No significant changes were observed over time. Multivariate analysis revealed that the odds of neurological complications were greater in the 2007-2011 period (OR = 1.51; 95% CI, 1.12-2.04), in patients with comorbidities (OR = 1.48; 95% CI, 1.16-1.88), and in hospitals with low case volume (OR = 1.69; 95% CI. 1.31-2.18). The odds of medical complications were also greater in the 2007-2011 period (OR = 1.69; 95%, CI 1.02-2.80). Female gender, non-Caucasian ethnicity, presence of comorbidities, and low hospital case volume were associated with greater odds of patients requiring further care.
Comorbidities and low hospital case volume were major risk factors for complications. No significant changes in rates of complications from vestibular schwannoma surgery were observed over the 15-year period.
我们旨在研究听神经瘤切除术的术后并发症，并确定其显著的临床预测因素。
横断面研究。
1997 年至 2011 年加利福尼亚医院住院患者数据集。
使用国际疾病分类第 9 版临床修正代码（ICD-9-CM）“04.01 听神经瘤切除术”提取加利福尼亚州实施的听神经瘤切除术的数据。检查了人口统计学、主要支付人、居住州、合并症以及医院病例量等因素作为可能的预测因素。术后并发症和患者转归作为结局变量进行了检查。合并症和并发症使用 ICD-9-CM 诊断和程序代码进行识别。
总共检查了 6553 例病例。2539 例（38.7%）患者存在合并症。1846 例（28.2%）患者发生术后并发症，其中 1714 例（26.2%）为神经并发症，337 例（5.1%）为医疗并发症。260 例（4.0%）患者的入院治疗以死亡或进一步治疗（即，熟练护理设施）结束。死亡率为 0.2%。未观察到随时间的显著变化。多变量分析显示，2007-2011 年期间神经并发症的几率更高（比值比[OR] = 1.51；95%置信区间[CI]，1.12-2.04），合并症患者（OR = 1.48；95%CI，1.16-1.88）和病例量低的医院（OR = 1.69；95%CI，1.31-2.18）。2007-2011 年期间医疗并发症的几率也更高（OR = 1.69；95%CI，1.02-2.80）。女性、非白种人种族、合并症和低医院病例量与患者需要进一步治疗的几率增加相关。
合并症和低医院病例量是并发症的主要危险因素。在 15 年期间，未观察到听神经瘤手术并发症发生率的显著变化。
