Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
School of Medicine, Louisiana State University Health Science Center at New Orleans, New Orleans, Louisiana, USA.
Otol Neurotol. 2024 Dec 1;45(10):1159-1166. doi: 10.1097/MAO.0000000000004320. Epub 2024 Sep 6.
Microsurgical resection is one of the treatments for vestibular schwannomas (VS). While several factors have been linked to increased length of stay (LOS) for VS patients undergoing microsurgery, a better understanding of these factors is important to provide prognostic information for patients.
Determine predictors of increased LOS for VS patients undergoing microsurgical resection.
Retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2010 to 2020.
Database review.
All patients who underwent microsurgery (CPT codes 61520, 61526/61596) for the management of vestibular schwannoma (ICD9 and ICD10 codes 225.1, D33.3) were included.
Analyzing perioperative factors that can predict prolonged hospital stay.
A total of 2096 cases were identified and 1,188 (57%) of these patients were female. The mean age was 51.0 ± 14.0 years. Factors contributing to prolonged LOS included African American race (OR = 2.11, 95% CI: 1.32-3.36, p = 0.002), insulin-dependent diabetes mellitus (OR = 2.12, 95% CI: 1.09-4.4.11, p = 0.026), hypertension (OR = 1.26, 95% CI: 1-1.58, p = 0.046), functional dependency (OR = 5.22, 95% CI: 2.31-11.79, p = 0.001), prior steroid use (OR = 1.96, 95% CI: 1.18-3.15, p = 0.009), ASA class III (OR = 2.06, 95% CI: 1.18-3.6, p < 0.011), ASA class IV (OR = 6.34, 95% CI: 2.62-15.33, p < 0.001), and prolonged operative time (OR = 2.14, 95% CI: 1.76-2.61). Microsurgery by a translabyrinthine (TL) approach compared to a retrosigmoid (RSG) approach had lower odds of prolonged LOS (OR = 0.67, 95% CI: 0.54-0.82, p < 0.001). In a separate analysis regarding patients receiving reoperation, operative time was the only predictor of prolonged LOS (OR = 2.77, 95% CI: 1.39-5.53, p = 0.004.).
Our analysis offers an analysis of the factors associated with a prolonged LOS for the surgical management of VS. By identifying healthcare disparities, targeting modifiable factors, and applying risk stratification based on demographics and comorbidities, we can work toward reducing disparities in LOS and enhancing patient outcomes.
显微切除术是治疗前庭神经鞘瘤（VS）的方法之一。虽然已经有几个因素与接受显微手术的 VS 患者的住院时间（LOS）延长有关，但更好地了解这些因素对于为患者提供预后信息很重要。
确定接受显微切除术治疗的 VS 患者 LOS 延长的预测因素。
使用美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据库进行回顾性分析，时间范围为 2010 年至 2020 年。
数据库审查。
所有接受显微手术（CPT 代码 61520、61526/61596）治疗前庭神经鞘瘤（ICD9 和 ICD10 代码 225.1、D33.3）的患者均纳入研究。
分析可预测住院时间延长的围手术期因素。
共确定了 2096 例病例，其中 1188 例（57%）为女性。平均年龄为 51.0±14.0 岁。导致 LOS 延长的因素包括非裔美国人种族（OR=2.11，95%CI：1.32-3.36，p=0.002）、胰岛素依赖型糖尿病（OR=2.12，95%CI：1.09-4.41，p=0.026）、高血压（OR=1.26，95%CI：1-1.58，p=0.046）、功能依赖（OR=5.22，95%CI：2.31-11.79，p=0.001）、术前使用类固醇（OR=1.96，95%CI：1.18-3.15，p=0.009）、ASA 分级 III（OR=2.06，95%CI：1.18-3.6，p<0.011）、ASA 分级 IV（OR=6.34，95%CI：2.62-15.33，p<0.001）和手术时间延长（OR=2.14，95%CI：1.76-2.61）。与经迷路（TL）入路相比，经乙状窦后（RSG）入路的显微手术具有较低的 LOS 延长可能性（OR=0.67，95%CI：0.54-0.82，p<0.001）。在一项关于接受再次手术患者的单独分析中，手术时间是 LOS 延长的唯一预测因素（OR=2.77，95%CI：1.39-5.53，p=0.004）。
我们的分析提供了与 VS 手术治疗的 LOS 延长相关因素的分析。通过识别医疗保健差异、针对可改变的因素以及根据人口统计学和合并症进行风险分层，我们可以努力减少 LOS 差异并改善患者结局。
