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DOI: 10.1055/s-0039-1692478
Risk Factors for 30-Day Non-Neurological Morbidity and Cerebrospinal Fluid Leak in Patients Undergoing Surgery for Vestibular Schwannoma
Funding No funds were received in support of this work.![](https://www.thieme-connect.de/media/jnlsb/202005/lookinside/thumbnails/10-1055-s-0039-1692478_190042-1.jpg)
Abstract
Introduction We analyzed perioperative risk factors for morbidity and mortality for the patients undergoing surgical intervention for vestibular schwannoma along with rates of cerebrospinal fluid (CSF) leaks that required surgery.
Materials and Methods Patients undergoing surgery vestibular schwannoma were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2016 using current procedural terminology (CPT) codes for posterior fossa surgical approaches and International Classification of Diseases 9th revision (ICD 9) and ICD 10 codes for peripheral nerve sheath tumor. Preoperative laboratories, comorbidities, and operative times were analyzed along with CSF leaks and unplanned returns to the operating room.
Results Nine-hundred ninety-three patients fit the inclusion criteria. Average age was 51, 41% were male, and 58% were female. Mortality within 30 days of the operation was very low at 0.4%, complications were 7% with infection being the most common at 2.3%, and unplanned reoperations happened in 7.4% of the cases. Dependent functional status (odds ratio [OR]: 5.7, 95% confidence interval [CI]: 1.9–16.6, p = 0.001), preoperative anemia (OR: 2.4, 95% CI: 1.2–4.5, p = 0.009), and operative time over 8 hours (OR: 1.9, 95% CI: 1.1–3.4, p = 0.017) were the only significant predictors of perioperative complications. CSF leak postoperatively occurred in 37 patients (3.7%). Reoperation for CSF leak was necessary in 56.3% of the cases. Operative time over 8 hours was the only independent significant predictor of postoperative CSF leak (OR: 2.2, 95% CI: 1.1–4.3, p = 0.028).
Conclusion Dependent functional status preoperatively, preoperative anemia, and duration of surgery over 8 hours are the greatest predictors of complications in the 30-day postoperative period.
Disclaimer
The manuscript submitted does not contain information about medical device(s)/drug(s).
Publikationsverlauf
Eingereicht: 24. Februar 2019
Angenommen: 11. Mai 2019
Artikel online veröffentlicht:
21. Juni 2019
Georg Thieme Verlag KG
Stuttgart · New York
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References
- 1 House JW, Nissen RL, Hitselberger WE. Acoustic tumor management in senior citizens. Laryngoscope 1987; 97 (02) 129-130
- 2 Sughrue ME, Yang I, Aranda D. et al. Beyond audiofacial morbidity after vestibular schwannoma surgery. J Neurosurg 2011; 114 (02) 367-374
- 3 Wiet RJ, Teixido M, Liang JG. Complications in acoustic neuroma surgery. Otolaryngol Clin North Am 1992; 25 (02) 389-412
- 4 Copeland WR, Mallory GW, Neff BA, Driscoll CL, Link MJ. Are there modifiable risk factors to prevent a cerebrospinal fluid leak following vestibular schwannoma surgery?. J Neurosurg 2015; 122 (02) 312-316
- 5 Russel A, Hoffmann CP, Nguyen DT, Beurton R, Parietti-Winkler C. Can the risks of cerebrospinal fluid leak after vestibular schwannoma surgery be predicted?. Otol Neurotol 2017; 38 (02) 248-252
- 6 Xia Y, Zhang W, Li Y, Ma X, Liu Q, Shi J. The transotic approach for vestibular schwannoma: indications and results. Eur Arch Otorhinolaryngol 2017; 274 (08) 3041-3047
- 7 Walker WB. The Oral Cavity and Associated Structures. In: Walker HK, Hall WD, Hurst JW. , editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. . Chapter 129
- 8 Kunert P, Dziedzic T, Czernicki T, Nowak A, Marchel A. Surgery for sporadic vestibular schwannoma. Part II. Complications (not related to facial and auditory nerves). Neurol Neurochir Pol 2016; 50 (02) 90-97
- 9 Mahboubi H, Ahmed OH, Yau AY, Ahmed YC, Djalilian HR. Complications of surgery for sporadic vestibular schwannoma. Otolaryngol Head Neck Surg 2014; 150 (02) 275-281
- 10 Sylvester MJ, Shastri DN, Patel VM. et al. Outcomes of vestibular schwannoma surgery among the elderly. Otolaryngol Head Neck Surg 2017; 156 (01) 166-172
- 11 Charpiot A, Tringali S, Zaouche S, Ferber-Viart C, Dubreuil C. Perioperative complications after translabyrinthine removal of large or giant vestibular schwannoma: outcomes for 123 patients. Acta Otolaryngol 2010; 130 (11) 1249-1255
- 12 Hersh EH, Sarkiss CA, Ladner TR. et al. Perioperative risk factors for thirty-day morbidity and mortality in the resection of extradural thoracic spine tumors. World Neurosurg 2018; 120: e950-e956
- 13 Lopez Ramos C, Brandel MG, Rennert RC. et al. Clinical risk factors and postoperative complications associated with unplanned hospital readmissions after cranial neurosurgery. World Neurosurg 2018; 119: e294-e300
- 14 Elsamadicy AA, Adogwa O, Ongele M. et al. Preoperative hemoglobin level is associated with increased health care use after elective spinal fusion (≥3 levels) in elderly male patients with spine deformity. World Neurosurg 2018; 112: e348-e354
- 15 Khanna R, Harris DA, McDevitt JL. et al. Impact of anemia and transfusion on readmission and length of stay after spinal surgery: a single-center study of 1187 operations. Clin Spine Surg 2017; 30 (10) E1338-E1342
- 16 Phan K, Dunn AE, Kim JS. et al. Impact of preoperative anemia on outcomes in adults undergoing elective posterior cervical fusion. Global Spine J 2017; 7 (08) 787-793
- 17 Muñoz M, Gómez-Ramírez S, Kozek-Langeneker S. Pre-operative haematological assessment in patients scheduled for major surgery. Anaesthesia 2016; 71 (Suppl. 01) 19-28
- 18 Goodnough LT, Maniatis A, Earnshaw P. et al. Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines. Br J Anaesth 2011; 106 (01) 13-22
- 19 Selesnick SH, Liu JC, Jen A, Newman J. The incidence of cerebrospinal fluid leak after vestibular schwannoma surgery. Otol Neurotol 2004; 25 (03) 387-393
- 20 Baird CJ, Hdeib A, Suk I. et al. Reduction of cerebrospinal fluid rhinorrhea after vestibular schwannoma surgery by reconstruction of the drilled porus acusticus with hydroxyapatite bone cement. J Neurosurg 2007; 107 (02) 347-351
- 21 Manjila S, Weidenbecher M, Semaan MT, Megerian CA, Bambakidis NC. Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh-hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma. J Neurosurg 2013; 119 (01) 113-120
- 22 Arriaga MA, Chen DA, Burke EL. Hydroxyapatite cement cranioplasty in translabyrinthine acoustic neuroma surgery-update. Otol Neurotol 2007; 28 (04) 538-540
- 23 Brennan JW, Rowed DW, Nedzelski JM, Chen JM. Cerebrospinal fluid leak after acoustic neuroma surgery: influence of tumor size and surgical approach on incidence and response to treatment. J Neurosurg 2001; 94 (02) 217-223
- 24 Becker SS, Jackler RK, Pitts LH. Cerebrospinal fluid leak after acoustic neuroma surgery: a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches. Otol Neurotol 2003; 24 (01) 107-112