Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Box 430, 405 30, Gothenburg, Sweden.
Department of Radiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.
Acta Neurochir (Wien). 2021 Aug;163(8):2225-2235. doi: 10.1007/s00701-021-04862-8. Epub 2021 May 7.
In patients with vestibular schwannomas (VS), tumor control is often achieved, and life expectancy is relatively good. The main risks of surgical treatment are hearing loss and facial nerve function. The occurrence of mood and sleeping disorders in relation to surgery is an important aspect of health that has rarely been studied. Similarly, only limited data exist on the rate of sick leave for patients with VS. In this nationwide registry-based study, we define the use of antidepressants and sedatives and the sick leave pattern before and after VS surgery.
Adult patients with histopathologically verified VS were identified in the Swedish Brain Tumor Registry (SBTR) and clinical data were linked to relevant national registries after assigning five matched controls to each patient. We studied patterns of dispensed antidepressants and sedative drugs as well as patterns of sick leave compared to respective controls at 2 years before and 2 years following surgery.
We identified 333 patients and 1662 matched controls. The rate of antidepressant use was similar between patients and controls 2 years before surgery (6.0% vs 6.3%) and 2 years after surgery (10.1% vs 7.5%). The rate of sedative use was also similar 2 years before surgery (3.9% vs 4.3%) and 2 years after surgery (4.8% vs 5.3%). The rate of sick leave was similar at baseline between patients and controls, but at 2 years after surgery, 75% of patients vs 88% of controls (p < 0.01) had no registered sick leave. Long-term sick leave after surgery was predicted by use of sedatives (OR 0.60, 95% CI 0.38-0.94, p = 0.03), more preoperative sick leave (OR 0.91, 95% CI 0.89-0.93, p < 0.001), and new-onset neurological deficits after surgery (OR 0.42, 95% CI 0.24-0.76, p = 0.004).
This nationwide study shows no significant differences in the use of antidepressants and sedatives between patients and controls, while the rate of postoperative sick leave was higher in patients than in controls after VS surgery. Our findings underpin the importance of avoiding surgical sequelae and facilitating return to normal professional life.
在听神经鞘瘤（VS）患者中，通常可以实现肿瘤控制，并且预期寿命相对较好。手术治疗的主要风险是听力损失和面神经功能障碍。与手术相关的情绪和睡眠障碍是健康的一个重要方面，但很少有研究对此进行研究。同样，关于 VS 患者的病假率也只有有限的数据。在这项基于全国范围登记的研究中，我们定义了使用抗抑郁药和镇静剂以及 VS 手术后前后的病假模式。
在瑞典脑肿瘤登记处（SBTR）中确定了经组织病理学证实的 VS 成年患者，并在为每个患者分配了 5 个匹配的对照后，将临床数据与相关的国家登记处进行了关联。我们研究了与各自的对照组相比，在手术前 2 年和手术后 2 年期间，抗抑郁药和镇静剂的使用模式以及病假模式。
我们确定了 333 名患者和 1662 名匹配的对照组。手术前 2 年，患者和对照组的抗抑郁药使用率相似（6.0% vs 6.3%），手术后 2 年也相似（10.1% vs 7.5%）。手术前 2 年，镇静剂使用率也相似（3.9% vs 4.3%），手术后 2 年也相似（4.8% vs 5.3%）。手术前，患者和对照组的病假率相似，但手术后 2 年，75%的患者（vs 88%的对照组）（p < 0.01）没有登记病假。手术后长期病假与使用镇静剂（OR 0.60，95%CI 0.38-0.94，p = 0.03）、更多术前病假（OR 0.91，95%CI 0.89-0.93，p < 0.001）和术后新发神经功能缺损（OR 0.42，95%CI 0.24-0.76，p = 0.004）相关。
这项全国性研究表明，患者和对照组之间使用抗抑郁药和镇静剂没有显着差异，而 VS 手术后患者的术后病假率高于对照组。我们的研究结果支持避免手术后遗症和促进恢复正常职业生活的重要性。
