Trends in surgical use and associated patient outcomes in the treatment of acoustic neuroma

Sahil Patel, Miriam Nuño, Debraj Mukherjee, Kristin Nosova, Shivanand P. Lad, Maxwell Boakye, Keith L. Black, Chirag G. Patil

Research output: Contribution to journalReview article

Abstract

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, R2 = 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.

Original languageEnglish (US)
Pages (from-to)142-147
Number of pages6
JournalWorld Neurosurgery
Volume80
Issue number1-2
DOIs
StatePublished - Jul 1 2013
Externally publishedYes

Fingerprint

Acoustic Neuroma
Odds Ratio
Inpatients
Radiosurgery
Insurance
Comorbidity
Multivariate Analysis
Databases
Mortality
Neoplasms

Keywords

  • Acoustic neuroma
  • Complications
  • Excision
  • Nonroutine discharge
  • Radiosurgery
  • Surgical trends

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Trends in surgical use and associated patient outcomes in the treatment of acoustic neuroma. / Patel, Sahil; Nuño, Miriam; Mukherjee, Debraj; Nosova, Kristin; Lad, Shivanand P.; Boakye, Maxwell; Black, Keith L.; Patil, Chirag G.

In: World Neurosurgery, Vol. 80, No. 1-2, 01.07.2013, p. 142-147.

Research output: Contribution to journalReview article

Patel, S, Nuño, M, Mukherjee, D, Nosova, K, Lad, SP, Boakye, M, Black, KL & Patil, CG 2013, 'Trends in surgical use and associated patient outcomes in the treatment of acoustic neuroma', World Neurosurgery, vol. 80, no. 1-2, pp. 142-147. https://doi.org/10.1016/j.wneu.2012.06.029
Patel, Sahil ; Nuño, Miriam ; Mukherjee, Debraj ; Nosova, Kristin ; Lad, Shivanand P. ; Boakye, Maxwell ; Black, Keith L. ; Patil, Chirag G. / Trends in surgical use and associated patient outcomes in the treatment of acoustic neuroma. In: World Neurosurgery. 2013 ; Vol. 80, No. 1-2. pp. 142-147.
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abstract = "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, R2 = 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.",
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AU - Lad, Shivanand P.

AU - Boakye, Maxwell

AU - Black, Keith L.

AU - Patil, Chirag G.

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