Trends in surgical use and associated patient outcomes in the treatment of acoustic neuroma.
OBJECTIVE
To investigate recent trends in surgical volume and associated patient outcomes in the treatment of acoustic neuromas.


METHODS
A retrospective analysis was performed using the Nationwide Inpatient Sample database from 2000-2007; cases from 2005 were excluded because of coding inconsistencies. Univariate and multivariate analyses were used to describe surgical trends and analyze inpatient outcomes.


RESULTS
Among 14,928 patients studied, 87.1% were treated at large (based on number of beds) hospitals. Cases at these hospitals declined progressively from 2054 to 1467 cases (a 28.6% decrease) from 2000-2007; a 40.8% (178 cases per year, R(2) = 0.73) reduction in surgeries was observed from 2001-2007. Although mortality remained steady at 0.3%, nonroutine discharge (increase from 10.9% to 19.1%) and complication rates (increase from 21.5% to 23.3%) increased in recent years. Patients without private insurance had an increased risk of nonroutine discharge (odds ratio [OR] 1.7, P = 0.0033; OR 1.5, P = 0.0382), and patients with more comorbidities had an increased risk of complications (OR 1.8, P < 0.0001; OR 1.5, P < 0.0001). High surgical caseload reduced nonroutine discharge by 30% (OR 0.7, P < 0.0001) and complications by 10% (OR 0.9, P < 0.0281).


CONCLUSIONS
A 41%, or 178 cases per year, reduction in surgical excision of acoustic neuroma cases was observed during the period 2001-2007. A possible explanation for this trend includes increased use of stereotactic radiosurgery. Nonroutine discharge and complications after surgical excision have increased perhaps because of surgery being used for larger tumors.
Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Sahil
S
Patel
Miriam
M
Nuño
Debraj
D
Mukherjee
Kristin
K
Nosova
Shivanand P
SP
Lad
Maxwell
M
Boakye
Keith L
KL
Black
Chirag G
CG
Patil
D000704:Analysis of Variance; D015897:Comorbidity; D003390:Cranial Nerve Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006276:Health Facility Size; D006801:Humans; D007182:Income; D007348:Insurance, Health / Q000706:statistics & numerical data; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D016634:Radiosurgery / Q000706:statistics & numerical data; D012306:Risk; D016896:Treatment Outcome