The Impact of a Multidisciplinary Perioperative Pathway on Vestibular Schwannoma Outcomes at a Tertiary Skull Base Center

Objective: To evaluate the impact of a multidisciplinary perioperative pathway on length of stay and postoperative outcomes after vestibular schwannoma surgery.

Setting: Tertiary skull base center.

Main Outcome Measures: The impact of the pathway on intensive care unit (ICU) length of stay (LOS) was evaluated as the primary outcome measure of the study. Overall resource LOS, postoperative complications, and readmission rates were also evaluated as secondary outcome measures.

Methods: Retrospective review.

Results: Ninety-six consecutive adult patients who underwent surgical resection for vestibular schwannoma were identified. All cases had pathologically confirmed vestibular schwannoma. 41 cases were preimplementation and 55 cases were postimplementation. A universally adopted perioperative pathway was focused on: standardization of preoperative education and expectations; intraoperative anesthetic delivery; postoperative nursing education; streamlining of postoperative rehabilitation; and optimizing utilization of step-down and surgical floor units after ICU stay ([Figs. 1] and [2]). There were no significant differences in the two groups with regard to tumor size, operative time, or medical comorbidities. The mean ICU-LOS decreased from 2.1 in the preimplementation group to 1.6 days in the postimplementation group (p = 0.02). There were no significant differences in overall resource LOS (already well-below national average), postoperative complications, or readmission rates between groups.

Conclusion: Multidisciplinary, perioperative neurotologic pathways can be effective in lowering ICU-LOS in patients undergoing vestibular schwannoma surgery. Further research is needed to continue to sustain and continuously improve these and other measures, while continuing to provide high-quality care to this patient population.

No conflict of interest has been declared by the author(s).