title: Outcomes of Vestibular Schwannoma Surgery among the Elderly.
abstract: Objective To compare comorbidities and in-hospital complications between elderly and nonelderly patients undergoing vestibular schwannoma (VS) surgery. To examine average length of stay (LOS) and hospital charges among elderly patients. Study Design Population-based inpatient registry analysis. Setting Academic medical center. Subjects and Methods Retrospective analysis of the National Inpatient Sample for patients undergoing VS surgery from 2002 to 2010: 4137 patients met inclusion criteria, with 519 (12.5%) in the elderly cohort (≥65 years). Outcomes of elderly and nonelderly (<65 years) patient cohorts were compared. Results Compared with the nonelderly cohort, the elderly cohort had more comorbidities, including diabetes mellitus, hypertension, and pulmonary disease (all P < .001). Elderly patients had longer LOS (6.5 vs 5.4 days; P = .001) but did not incur significantly greater hospital charges. Rates of cerebrospinal fluid leak, meningitis, and facial nerve injury did not vary significantly between groups. The elderly cohort experienced higher rates of in-hospital complications, including acute cardiac events, iatrogenic cerebrovascular infarction/hemorrhage, postoperative bleeding (hemorrhage/hematoma), and in-hospital mortality (all P < .05). In binary logistic regression, correcting for patient demographics and presence of comorbidities, elderly status was associated with 1.848 (95% confidence interval, 1.167-2.927; P = .009) greater odds of medical complications and 13.188 (95% confidence interval, 1.829-95.113; P = .011) greater odds of in-hospital mortality. Conclusion Elderly patients undergoing VS surgery have more comorbidities, in-hospital complications, and longer LOS than nonelderly patients. The elderly cohort had a greater rate of in-hospital mortality, though rare. Interestingly, elderly patients did not have a higher rate of many known complications associated with VS surgery and did not incur more hospital charges.
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sylvester
authors.affiliation: 2 Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Darshan N
authors.initials: DN
authors.lastname: Shastri
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Viral M
authors.initials: VM
authors.lastname: Patel
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Milap D
authors.initials: MD
authors.lastname: Raikundalia
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.|2 Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.|3 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA.|4 Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.|3 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Soly
authors.initials: S
authors.lastname: Baredes
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Yu-Lan Mary
authors.initials: YM
authors.lastname: Ying
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome
keywords: HCUP; Nationwide Inpatient Sample (NIS); acoustic neuroma; cerebrospinal fluid leak; elderly surgical outcomes; geriatric surgical oncology; in-hospital mortality; postoperative outcomes; surgery complications; vestibular schwannoma surgery