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  • Microvascular Decompression: Costs, Complications, and Re-operation Rates from National Level Data

    Final Number:

    Anand Veeravagu MD; Bowen Jiang BS; Kevin Huang BA; Beatrice Ugiliweneza MSPH; Paul S.A. Kalanithi MD; Melanie G. Hayden Gephart MD MAS; Chirag G. Patil MD MS; Maxwell Boakye MD; Shivanand P. Lad MD PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Microvascular decompression (MVD) is a well-accepted technique for the surgical management of various cranial neuropathies. While many studies have examined the outcomes of MVD in single-center trials, we sought to determine the re- operation rate in a large, independent cohort of patients undergoing MVD surgery.

    Methods: The Reuter’s MarketScan database was utilized to perform a retrospective, population-based study. Patients who underwent MVD for trigeminal neuralgia, hemifacial spasm or glossopharyngeal neuralgia between 2000 and 2009. Of the 278 MVD procedures identified, all patients with less than 2 years of post-operative follow-up data were excluded. The records of the remaining 113 patients were analyzed using a logistic regression analysis examining long-term complication and re-operation rates, type of re-operation and outpatient healthcare resource utilization.

    Results: The study sample included 278 patients with a total of 113 patients with >2 year follow-up. The mean age was 56 years, 67% female, 68% Commercial insurance, 87% with low comorbidities (Charlson index= 0) and mean follow-up of 4 years. The 1, 2 and long-term re-operation rates were 2.7%, 3.5% and 4.4%, respectively. Post-operative complications totaled 8.0% at 90 days. Re-operation consisted of redo MVD (3.5%), balloon decompression (1.8%), and radiosurgery (0.88%). Average time to re-operation was 3.8 years and 2 year follow-up resulted in hospital charges totaling $9018, outpatient services of $9384, and medication charges of $4906.

    Conclusions: In this large, retrospective study, MVD remains a robust procedure that is well-tolerated. Repeat MVD remains the first-line choice for those requiring re-operation.

    Patient Care: Our research will help clinicians identify effective second-line treatment strategies for cranial neuropathy patients who fail initial therapy with MVD.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the incidence and epidemiology of patients undergoing redo operation after initial MVD 2) Be able to discuss the efficacy, costs, and complication rates associated with the various types of re-operations.


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