Postoperative Complications and Readmission Rates Following Surgery for Cerebellopontine Angle Schwannomas

Abstract

Objective To investigate the 30-day postoperative complication, readmission, and reoperation rates following surgery for cerebellopontine angle (CPA) schwannomas. Study Design Cross-sectional analysis. Setting National surgical quality improvement program dataset (NSQIP) 2009 through 2013. Patients All surgical cases with an International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) diagnosis code of 225.1, benign neoplasms of cranial nerves, and one of the following current procedural terminology (CPT) codes, were included: 61616, 61526, 61530, and 61520. Intervention(s) Surgical resection as indicated by the CPT codes above. Main Outcome Measure(s) Demographics, comorbidities, 30-day postoperative complications, readmission rate, and reoperation rate. Results Overall, 404 cases were identified, of which 42.6% were men. The average age was 51 years. Comorbidities were present in 45.3%. NSQIP-tracked complications occurred in 9.7% of patients. Most common complications were wound infections including surgical-site infection and wound dehiscence (11 patients, 2.7%), sepsis (10 patients, 2.5%), blood loss (nine patients, 2.2%), and deep vein thrombosis (DVT; seven patients, 1.7%). Mortality occurred in four patients (1.0%). The complication rate was statistically higher in patients with comorbidities versus those without (10.2% versus 4.1%, p = 0.04). Patients with complications were more likely to undergo reoperation (2.5% with versus 4.1% without, p = 0.001). Unplanned readmissions occurred in 41 cases (10.1%) and reoperations occurred in 23 patients (5.7%). Conclusions Most common NSQIP-tracked complications in excision of CPA neoplasms are infections, sepsis, blood loss, and deep vein thrombosis (DVT). Further, investigation of patients with unplanned readmission and reoperation are warranted. Neurotologists need to take an active role in the data to be gathered in the NSQIP database as it relates to vestibular schwannomas.

Prognostic value of transcranial facial nerve motor-evoked potentials in predicting facial nerve function following cerebellopontine angle tumorectomy

“…Cerebellopontine angle (CPA) neoplasms comprise approximately 10% of all intracranial tumors. [ 1 ] Surgical resection is the mainstream therapeutic option for these entities, and cranial nerve damage is a common complication following CPA surgery. [ 2 , 3 ] Patients may develop facial nerve paralysis immediately after surgery or may develop an early delayed postoperative paralysis, which severely impairs the individual's quality of life.…”

Variation in Coding Practices for Vestibular Schwannoma Surgery

“…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.…”

“…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.…”

Deep Venous Thrombosis Chemoprophylaxis in Lateral Skull Base Surgery for Vestibular Schwannoma

“…Additionally, Smith et al did not find the use of postoperative chemoprophylaxis to be associated with a reduced rate of DVT ( P = .76) . Mahboubi et al conducted a cross‐sectional analysis of postoperative complications of patients who underwent craniotomy using the NSQIP database . In contrast to the Smith et al study, Mahboubi et al found a DVT rate of 1.7% and PE rate of 0.5% in patients undergoing craniotomy for vestibular schwannoma .…”

“…Mahboubi et al conducted a cross‐sectional analysis of postoperative complications of patients who underwent craniotomy using the NSQIP database . In contrast to the Smith et al study, Mahboubi et al found a DVT rate of 1.7% and PE rate of 0.5% in patients undergoing craniotomy for vestibular schwannoma . There were no reported events of ICH, but there was a 1% rate of cerebrovascular accident (CVA) .…”