Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA.
Department of Neurological Surgery, University of California, Irvine, USA.
Clin Neurol Neurosurg. 2020 Oct;197:106192. doi: 10.1016/j.clineuro.2020.106192. Epub 2020 Aug 28.
To evaluate whether increased body mass index (BMI), age, or frailty influence vestibular schwannoma (VS) short-term surgical morbidity.
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.
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 min; 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 (n=109) was associated with LOS (4.7±3.5 vs. 5.3 ± 4.1 vs. 6.7 ± 6.6 days, p < 0.001) and prolonged intubation rates (1.0 % vs. 2.4 % vs. 3.7 %; p = 0.03).
Increased age, BMI, and frailty among VS patients were associated with different post-operative complication rates, operation time, or LOS. Knowledge of these can optimize care for at-risk patients.
评估体重指数（BMI）、年龄或虚弱程度是否会影响听神经鞘瘤（VS）的短期手术发病率。
查询了 2005-2017 年国家手术质量改进计划数据库中接受 VS 切除术的患者。根据年龄<50、50-64 和≥65 进行分层，而 BMI 则根据 30 的阈值进行分层。虚弱评分（0-5）根据功能状态、糖尿病、慢性阻塞性肺疾病、充血性心力衰竭和高血压来表示。
共纳入 1405 例患者，其中 56.7%为女性，平均年龄为 50.7±13.8 岁，平均 BMI 为 29.4±6.6。<50 岁（n=604）、50-64 岁（n=578）和≥65 岁（n=223）患者的手术时间不同（428±173 vs. 392±149 vs. 387±154 分钟；p<0.001）和 30 天死亡率（0.7%vs. 0%vs. 1.8%；p=0.01）。然而，术后住院时间（p=0.16）、再入院率（p=0.08）、再次手术率（p=0.54）和并发症发生率相似。肥胖组（BMI≥30）术后心肌梗死（p=0.03）和伤口感染（p=0.02）更为常见，但再入院率（p=0.18）、再次手术率（p=0.44）和并发症发生率与 BMI<30 的患者相似。重度肥胖患者（BMI≥35）深静脉血栓形成（DVT）发生率更高（p=0.004）。虚弱评分 0（n=921）、1（n=375）和 2-4（n=109）与 LOS（4.7±3.5 vs. 5.3±4.1 vs. 6.7±6.6 天，p<0.001）和延长插管率（1.0%vs. 2.4%vs. 3.7%；p=0.03）相关。
VS 患者的年龄、BMI 和虚弱程度与不同的术后并发症发生率、手术时间或 LOS 相关。了解这些信息可以为高危患者提供最佳护理。
