Morbid obesity increases risk of morbidity and reoperation in resection of benign cranial nerve neoplasms

Murphy, Meghan; McCutcheon, Brandon A.; Kerezoudis, Panagiotis; Porter, Amanda; Rinaldo, Lorenzo; Shepherd, Daniel; Rayan, Tarek; Maloney, Patrick R.; Carter, Bob S.; Bydon, Mohamad; Gompel, Jamie J. Van; Link, Michael J.

doi:10.1016/j.clineuro.2016.06.020

Cited by 18 publications

(18 citation statements)

References 25 publications

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“…The physiological effects of elevated BMI may confer higher levels of procedural risk and subsequent complications, particularly for patients undergoing open intracranial surgery. 3,26,30 Whether BMI affects the clinical course of patients with aSAH in a treatment modality-dependent manner is not ABBREVIATIONS aSAH = aneurysmal subarachnoid hemorrhage; BMI = body mass index; CART = classification and regression tree; DCI = delayed cerebral ischemia; mRS = modified Rankin Scale; WFNS = World Federation of Neurosurgical Societies.OBJECTIVE It has been suggested that increased body mass index (BMI) may confer a protective effect on patients who suffer from aneurysmal subarachnoid hemorrhage (aSAH). Whether the modality of aneurysm occlusion influences the effect of BMI on patient outcomes is not well understood.…”

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confidence: 99%

Effect of body mass index on outcome after aneurysmal subarachnoid hemorrhage treated with clipping versus coiling

Rinaldo¹,

Hughes²,

Rabinstein

et al. 2018

Journal of Neurosurgery

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OBJECTIVE It has been suggested that increased body mass index (BMI) may confer a protective effect on patients who suffer from aneurysmal subarachnoid hemorrhage (aSAH). Whether the modality of aneurysm occlusion influences the effect of BMI on patient outcomes is not well understood. The authors aimed to compare the effect of BMI on outcomes for patients with aSAH treated with surgical clipping versus endovascular coiling. METHODS The authors retrospectively reviewed the outcomes for patients admitted to their institution for the management of aSAH treated with either clipping or coiling. BMI at the time of admission was recorded and used to assign patients to a group according to low or high BMI. Cutoff values for BMI were determined by classification and regression tree analysis. Predictors of poor functional outcome (defined as modified Rankin Scale score > 2 measured ≥ 90 days after the ictus) and posttreatment cerebral hypodensities detected during admission were then determined separately for patients treated with clipping or coiling using stepwise multivariate logistic regression analysis. RESULTS Of the 469 patients admitted to the authors' institution with aSAH who met the study's inclusion criteria, 144 were treated with clipping and 325 were treated with coiling. In the clipping group, the frequency of poor functional outcome was higher in patients with BMI ≥ 32.3 kg/m (47.6% vs 19.0%; p = 0.007). In contrast, in the coiling group, patients with BMI ≥ 32.3 kg/m had a lower frequency of poor functional outcome at ≥ 90 days (5.8% vs 30.9%; p < 0.001). On multivariate analysis, high BMI was independently associated with an increased (OR 3.92, 95% CI 1.20-13.41; p = 0.024) and decreased (OR 0.13, 95% CI 0.03-0.40; p < 0.001) likelihood of poor functional outcome for patients treated with clipping and coiling, respectively. For patients in the surgical group, BMI ≥ 28.4 kg/m was independently associated with incidence of cerebral hypodensities during admission (OR 2.44, 95% CI 1.16-5.25; p = 0.018) on multivariate analysis. For patients treated with coiling, BMI ≥ 33.2 kg/m was independently associated with reduced odds of hypodensities (OR 0.45, 95% CI 0.21-0.89; p = 0.021). CONCLUSIONS The results of this study suggest that BMI may differentially affect functional outcomes after aSAH, depending on treatment modality. These findings may aid in treatment selection for patients with aSAH.

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confidence: 99%

Effect of body mass index on outcome after aneurysmal subarachnoid hemorrhage treated with clipping versus coiling

Rinaldo¹,

Hughes²,

Rabinstein

et al. 2018

Journal of Neurosurgery

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“…Nationwide databases are increasingly employed for analyses of trends across the population and may provide a valuable resource for uncommon pathologies such as skull base tumors. [2][3][4][5][6][7][8] Aggregated data mitigate certain biases inherent to single institution data and small sample sizes and has been applied to study risk factors for negative clinical outcomes, readmissions, and re-operations for surgical procedures. Additionally, the availability of CPT codes in large de-identified databases has prompted conclusions regarding specific surgical approaches.…”

Section: Discussionmentioning

confidence: 99%

“…Databases that include CPT coding are especially relevant for relatively uncommon pathologies such as vestibular schwannoma. [2][3][4][5][6][7][8] Despite these advantages, increased attention has been directed toward the limitations and potential inaccuracies of national databases for neurosurgical research. 9,10 While the inter-rater reliability of databases has been rated as good, there remains limited knowledge on whether databases precisely reflect the nuances of coding for skull base pathologies.…”

Section: Introductionmentioning

confidence: 99%

Variation in Coding Practices for Vestibular Schwannoma Surgery

Mooney

Yoon

et al. 2018

J Neurol Surg B

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Introduction Nationwide databases are frequently used resources for assessing practice patterns and clinical outcomes. However, analyses based on billing codes may be limited by the inconsistent application of current procedural terminology (CPT) codes to specific operations. We investigated the variability among commonly used CPT codes for vestibular schwannomas resection and sought to identify factors that underlie this variation. Methods The surgical procedure for 274 cases of vestibular schwannoma resections from two institutions was reviewed and classified as retrosigmoid, translabyrinthine, or middle fossa approaches. We then assessed the CPT codes assigned to each case and analyzed their association with surgical approach, surgeons involved, the coding specialty, and year of surgery. We further compared the incidence of CPT codes assigned for vestibular schwannoma surgeries in the American College Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2010 to 2014. Results The majority (65%) of vestibular schwannoma resections within the institutional cohort were billed with skull base approach and/or excision codes, whereas 76% of cases in NSQIP were associated with a single craniotomy for tumor code. The use of skull base codes over the past decade increased within our institutional cohort but remained relatively stable within NSQIP. CPT codes did not consistently reflect the operative approaches for vestibular schwannomas. Conclusion We observed significant variability in coding patterns for vestibular schwannoma surgeries within institutions, surgical practices, and national databases. These results call for discretion in interpretation of data from aggregated billing code-based nationwide databases and suggests a role for institutional standardization of CPT assignments for the same approaches.

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“…[26][27][28] There is also a body of evidence that overweight (BMI 25-29.9) and obese (BMI 30-39.9) patients are at greater risk for cerebrospinal fluid leak in VS resection and that morbid obesity (BMI ≥ 40) is associated with increased morbidity and greater risk of reoperation. 13,29 This study examined various medical comorbidities to identify any changes over the included study period. In short, age, BMI, and ASA classification were largely stable over the study period for all three surgical cohorts.…”

Section: Medical Comorbiditiesmentioning

confidence: 99%

“…This database has been previously validated for its success in improving surgical morbidity and mortality, 11 ability to assess clinical outcomes, and direct quality improvement in research efforts with regards to adult cranial nerve lesions. [12][13][14]…”

Section: Introductionmentioning

confidence: 99%

Surgical Management of Vestibular Schwannoma: Practice Pattern Analysis via NSQIP

Patel

Dunklebarger

Banerjee

et al. 2019

Ann Otol Rhinol Laryngol

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Objective: Characterize current perspectives in the surgical management of vestibular schwannoma (VS) to guide otolaryngologists in understanding United States practice patterns. Methods: A retrospective analysis of ACS-NSQIP database was performed to abstract all patients from 2008 to 2016 who underwent VS resection using ICD-9/10 codes 225.1 and D33.3, respectively. The specific surgical approach employed was identified via CPT codes 61520, 61526/61596, and 61591, which represent retrosigmoid (RS), translabyrinthine (TL) and middle cranial fossa (MCF) approaches, respectively. Analyzed outcomes include general surgical complications, total length of stay, and reoperation. Results: A total of 1671 VS cases were identified, 1266 (75.7%) were RS, 292 (17.5%) were TL, and 114 (6.8%) were MCF. The annual number of cases increased over the study period from 15 to 375, which is chiefly attributed to increased institutional participation in ACS-NSQIP. Perioperative variables including BMI ( P < .001), ASA class ( P = .004), ethnicity ( P = .008), operative time ( P < .001), and reoperation ( P < .001) were found to be statistically significant between cohorts. Increased utilization of RS approach was consistent over the entire study period, with significantly more RS performed than either TL or MCF. Finally, a statistically significant difference with respect to general surgical complication rates was not noted between surgical approaches. Conclusions: There is increased employment of RS approach for the operative management of VS, which likely is the result of increased reliance on both stereotactic radiosurgery and observation as alternative treatment strategies.

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Morbid obesity increases risk of morbidity and reoperation in resection of benign cranial nerve neoplasms

Cited by 18 publications

References 25 publications

Effect of body mass index on outcome after aneurysmal subarachnoid hemorrhage treated with clipping versus coiling

Effect of body mass index on outcome after aneurysmal subarachnoid hemorrhage treated with clipping versus coiling

Variation in Coding Practices for Vestibular Schwannoma Surgery

Surgical Management of Vestibular Schwannoma: Practice Pattern Analysis via NSQIP

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