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.
Keywords
vestibular schwannoma - complications - CSF leak - reoperation