Introduction: Iterative refinement of skull base approaches have dramatically improved outcomes in the recent decades. Of particular concern are reducing the rates of CSF leaks and damage to acoustic or facial nerves during acoustic neuroma resection, with consequent improvement in quality of life following surgery.
Methods: Statewide inpatient datasets comprising 100% of hospital discharges in the 3 most populous states with longitudinal identifiers (CA, FL, NY), which track patients across multiple admissions, institutions, and years, were examined for 2006-2010. Algorithms constructed from ICD-9 codes and validated by chart review identified acoustic neuroma resection and prospectively-designated predictors and outcomes. Initial resections in either 2006 or 2010 were excluded to ensure at least 1yr of follow-up. Primary outcomes analyzed were readmissions for re-operation, CSF leak, hearing loss, facial weakness. Secondary outcomes were readmissions with neurological events or infections, death during the operative admission and costs. Predictors included presenting neurological sequelae and comorbidites, hospital volume, Charlson comorbidity index, and demographics.
Results: CA, FL, and NY together comprise 24% of the US population. After exclusion, there were a total of 1,957 patients who underwent acoustic neuroma resection. 4% of patients were readmitted for re-operation (median time to readmission: 207days, IQR:36-507) and 12% were readmitted with new-onset CSF leak (6%; median 15days, IQR:9-44), hearing loss (5%; median 55days, IQR:12-268), and facial weakness (0.4%; median 18days, IQR:5-148). Additionally, 0.3% of patients died during the initial operative admission (median 10days after resection, IQR:4-28). Readmissions for new-onset hydrocephalus (2%; median 46days, IQR:20-297), convulsions (1%; median 46days, IQR:12-269), and hemorrhage (1%; median 30days, IQR:12-189) were associated with comorbidities at presentation, and readmissions for infection (7%; median 38days, IQR:14-190), were predominantly for meningitis (2%; median 18days, IQR:12-41), UTI (2%; median 37days, IQR:12-303), and wound dehiscence (1%; median 28days, IQR:15-119).
Conclusions: Readmission rates with CSF leaks, hearing loss, or facial weakness are persistently low following excision of acoustic neuromas, and are associated with comorbidities at presentation. Additionally, mortality rates in the perioperative period, while almost zero, demonstrate room for continued prudence and improvement. These findings reinforce the strides made in the neurosurgical paradigms for skull base approaches and resulting outcomes.
Patient Care: These findings reinforce the strides made in the neurosurgical paradigms for skull base approaches and resulting outcomes, highlighting the need for continued improvement in postop quality of life.
Learning Objectives: Participants should be able to better understand the incidence of 1) acoustic neuroma resection, 2) associated comorbidities,and 3) predictors for postop outcomes.