Is There a Difference in Hospital Stay between Patients undergoing Translabyrinthine or Retrosigmoid Surgery for Vestibular Schwannoma Stratified by Tumor Size?

Visagan, Ravindran; Hall, Andrew B.; Bradford, Robert; Khalil, S. Abi; Saeed, Shakeel R

doi:10.1055/s-0038-1668541

Cited by 9 publications

(6 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies have shown that tumor size is correlated with postoperative LOS following VS surgery. 27,35 However, to our knowledge this is the first study to specifically look at brainstem compression as an independent predictor of LOS regardless of tumor size. Larger tumors are more often associated with brainstem compression, which can complicate surgery and postoperative care, thereby increasing LOS.…”

Section: Discussionmentioning

confidence: 93%

“…26 Beyond the economic implications of LOS, prolonged hospital stay may place an otherwise healthy patient at risk of nosocomial infections. 27 Previous reports in the general surgery literature demonstrate advanced age impacts postoperative LOS. 28,29 Additionally, previous data has shown advanced age significantly impacts intensive care LOS following VS surgery, 25 and advanced age (>65 years) prolongs hospital LOS following VS surgery.…”

Section: Discussionmentioning

confidence: 98%

“…However, it is important to note, we did not stratify LOS by tumor size. Visagan et al 27 showed that for large tumors (31-40 mm), patients undergoing TL approach had a significantly shorter LOS than patients undergoing RS approach (7 vs 11 days) as well as a significantly shorter intensive care stay. These differences were not significant for smaller tumors.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Tumor-Related and Patient-Related Variables Affecting Length of Hospital Stay Following Vestibular Schwannoma Microsurgery

Almosnino

Sikora

Farrokhi

et al. 2021

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

Objective: Review a single institution’s vestibular schwannoma (VS) microsurgery experience to determine (1) correlations between demographics, comorbidities, and/or surgical approach on hospital length of stay (LOS) and discharge disposition and (2) trends in surgical approach over time. Methods: Retrospective case series from a multidisciplinary skull base program at a tertiary care, academic hospital. All adult (>18 years) patients undergoing primary microsurgery for VS between 2008 and 2018 were included. Results: A total of 147 subjects were identified. Surgical approach was split between middle fossa (MF) (16%), retrosigmoid (RS) (35%), and translabyrinthine (TL) (49%) craniotomies. For the 8% of patients had other than routine (OTR) discharge. Mean LOS was significantly longer for patients undergoing RS than either MF or TL. Brainstem compression by the tumor was associated with longer LOS as were diagnoses of chronic obstructive pulmonary disease (COPD) and peripheral vascular disease (PVD). For all discharges, the 40 to 50- and 50 to 60-year-old subgroups had significantly shorter LOS than the 70-years-and-older patients. For the 92% of patients routinely discharged, there was a significantly shorter LOS in the 40 to 50-year-olds compared to the 70-years-and-older patients. There was a significant shift in surgical approach from RS to TL over the study period. Conclusion: Over 90% of VS microsurgery patients were routinely discharged with a median hospital LOS of 3.2 days, both of which are consistent with published data. There is an inverse relationship between age and LOS with patients older than 70 years having significantly longer LOS. Brainstem compression, COPD, PVD, and the RS approach negatively affect LOS. Level of Evidence 4

show abstract

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Tumor-Related and Patient-Related Variables Affecting Length of Hospital Stay Following Vestibular Schwannoma Microsurgery

Almosnino

Sikora

Farrokhi

et al. 2021

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

show abstract

“…As with any observational study, there is inevitably unmeasured confounding that may account for some of the observed association between excess time in the hospital and facility volume. Surgical approach, for example, is associated with length of stay independent of tumor size . Surgeon volume may play a role in perioperative complications and prolonged length of stay, but surgeon-level data are not available in the NCDB.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical approach, for example, is associated with length of stay independent of tumor size. 26 Surgeon volume may play a role in perioperative complications and prolonged length of stay, but surgeon-level data are not available in the NCDB. Variance in length of stay may also be associated with the day of the week surgery is performed, as surgeries performed later in the week must contend with more limited staffing on the weekends, which may be associated with prolonged stay.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Association Between Facility Surgical Volume and Excess Time in the Hospital After Surgical Resection of Vestibular Schwannomas

Dixon

Moshtaghi

Harris

et al. 2023

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

ImportanceHigh surgical vestibular schwannoma case volume in a medical institution may decrease the risk of adverse outcomes among patients undergoing vestibular schwannoma surgery.ObjectiveTo study the association between surgical vestibular schwannoma case volume and excess time in the hospital after vestibular schwannoma surgery.Design, Setting, and ParticipantsThis cohort study evaluated data from the National Cancer Database from January 1, 2004, through December 31, 2019, on Commission on Cancer–accredited facilities in the US. The hospital-based sample comprised adult patients aged 18 years or older with a vestibular schwannoma treated with surgery.ExposuresFacility case volume, defined as the mean number of surgical vestibular schwannoma cases per year in the 2 years preceding the index case.Main Outcomes and MeasuresThe primary outcome was a composite of prolonged hospital stay (&gt;90th percentile) or 30-day readmission. Risk-adjusted restricted cubic splines were used to model the probability of the outcome according to facility volume. The inflection point (in cases per year) when the declining risk of excess time in the hospital began to plateau was selected as the threshold to define high- and low-volume facilities. Outcomes were compared among patients treated at high- and low-volume facilities, with mixed-effects logistic regression models adjusting for patient sociodemographic characteristics, comorbidities, tumor size, and clustering within facilities. Collected data were analyzed between June 24 and August 31, 2022.ResultsAmong 11 524 eligible patients (mean [SD] age, 50.2 [12.8] years; 53.5% female; 46.5% male) who underwent surgical resection of vestibular schwannoma at 66 reporting facilities, the median length of stay was 4 (IQR, 3-5) days, and 655 patients (5.7%) were readmitted within 30 days. The median case volume was 16 (IQR, 9-26) cases per year. An adjusted restricted cubic spline model identified a downtrending probability of excess time in the hospital with increasing volume. The declining risk of excess time in the hospital began to plateau at a facility volume of 25 cases per year. Surgery at a facility with an annual case volume at or above this threshold was independently associated with a 42% reduction in the odds of excess time in the hospital compared with surgery at a low-volume center (odds ratio, 0.58; 95% CI, 0.44-0.77).Conclusions and RelevanceThis cohort study found that among adults undergoing vestibular schwannoma surgery, a higher facility case volume was associated with a reduced risk of prolonged hospital stay or 30-day readmission. A facility case volume of 25 cases per year may represent a risk-defining threshold.

show abstract

Translabyrinthine versus Retrosigmoid Approach for Vestibular Schwannoma: A Systematic Review and An Updated Meta‐Analysis

Gibbon,

Lindner,

Vial

et al. 2024

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

ObjectiveSeveral approaches can be used in the surgical treatment of vestibular schwannoma (VS), and the best approach remains uncertain in the literature. This systematic review and meta‐analysis aim to compare the translabyrinthine approach (TLA) with the retrosigmoid approach (RSA) for VS in terms of postoperative complications.Data SourcesPubMed, Web of Science, Embase, and Cochrane.Review MethodsThe primary outcome was cerebrospinal fluid (CSF) leak; secondary outcomes were facial nerve dysfunction (FND), length of stay (LOS), and meningitis. Statistical analysis was performed using RStudio 2024.04.1 + 748. Heterogeneity was assessed with I² statistics. We performed sensitivity analysis with subgroup analysis and meta‐regression. Risk of bias was assessed using ROBINS‐I.ResultsOut of 1140 potential articles, 21 met the inclusion criteria. Among the 4572 patients, 2687 and 1885 patients in the TLA and RSA groups, respectively. No significant differences were found in CSF leak (odds ratio [OR] 1.03; 95% confidence interval [CI] 0.81,1.32; P = .794) or meningitis (OR 1.05; 95% CI 0.45, 2.43; P = .73). Meta‐regression showed no association with CSF leak and the number of cases per center or publication year. The TLA is associated with a shorter LOS (MD −1.20; 95% CI −1.39, −1.01; P < .01) and a higher chance of having and HB 4 or lower compared to patients who underwent RSA (OR 0.30; 95% CI 0.10, 0.89; P = .03).ConclusionThere was no difference in the odds of CSF leak or meningitis between the groups. In addition, the TLA has a shorter LOS and a higher chance of a better facial nerve outcome compared to the RSA.

show abstract

Is There a Difference in Hospital Stay between Patients undergoing Translabyrinthine or Retrosigmoid Surgery for Vestibular Schwannoma Stratified by Tumor Size?

Cited by 9 publications

References 7 publications

Tumor-Related and Patient-Related Variables Affecting Length of Hospital Stay Following Vestibular Schwannoma Microsurgery

Tumor-Related and Patient-Related Variables Affecting Length of Hospital Stay Following Vestibular Schwannoma Microsurgery

Association Between Facility Surgical Volume and Excess Time in the Hospital After Surgical Resection of Vestibular Schwannomas

Translabyrinthine versus Retrosigmoid Approach for Vestibular Schwannoma: A Systematic Review and An Updated Meta‐Analysis

Contact Info

Product

Resources

About