Publication year: 2012
Source:World Neurosurgery
Sahil Patel, Miriam Nuño, Debraj Mukherjee, Kristin Nosova, Shivanand P. Lad, Maxwell Boakye, Keith L. Black, Chirag G. Patil
Objective The emergence of stereotactic radiosurgery has provided an alternative to traditional surgical excision in the treatment of acoustic neuromas. In our study, we investigate the recent trends in surgical volume and associated patient outcomes in the treatment of this neoplasm. Methods A retrospective analysis was carried out using the Nationwide Inpatient Sample (NIS) database from 2000 to 2007; cases from 2005 were excluded due to coding inconsistencies. Univariate and multivariate analyses were used to describe surgical trends and analyze in-patient outcomes. Results Among the 14,928 patients studied, 87.1% were treated at large bed-size hospitals. Cases at these hospitals declined progressively from 2054 to 1467 cases (a 28.6% decrease) between 2000 and 2007; however, a 40.8% (178 cases per year, R2=.73) reduction in surgeries was observed from 2001 to 2007. While mortality remained steady at 0.3%, non-routine discharge (10.9% to 19.1%) and complication rates (21.5% to 23.3%) increased in recent years. Patients without private insurance (OR 1.7, p=.0033; OR 1.5, p=.0382), and higher comorbidity (OR 1.8, p<.0001; OR 1.5, <.0001) had an increased risk of non-routine discharge and complications, respectively. High surgical case-load reduced non-routine discharge by 30% (OR 0.7, p<.0001) and complications by 10% (OR 0.9, p<.0281). Conclusions A 41% or 178 cases per year reduction in surgical excision of acoustic neuroma cases was observed between 2001 and 2007. A possible explanation for this trend includes increased utilization of stereotactic radiosurgery. Non-routine discharge and complications after surgical excision have increased perhaps due to surgery being utilized for larger tumors.
Source:World Neurosurgery
Sahil Patel, Miriam Nuño, Debraj Mukherjee, Kristin Nosova, Shivanand P. Lad, Maxwell Boakye, Keith L. Black, Chirag G. Patil
Objective The emergence of stereotactic radiosurgery has provided an alternative to traditional surgical excision in the treatment of acoustic neuromas. In our study, we investigate the recent trends in surgical volume and associated patient outcomes in the treatment of this neoplasm. Methods A retrospective analysis was carried out using the Nationwide Inpatient Sample (NIS) database from 2000 to 2007; cases from 2005 were excluded due to coding inconsistencies. Univariate and multivariate analyses were used to describe surgical trends and analyze in-patient outcomes. Results Among the 14,928 patients studied, 87.1% were treated at large bed-size hospitals. Cases at these hospitals declined progressively from 2054 to 1467 cases (a 28.6% decrease) between 2000 and 2007; however, a 40.8% (178 cases per year, R2=.73) reduction in surgeries was observed from 2001 to 2007. While mortality remained steady at 0.3%, non-routine discharge (10.9% to 19.1%) and complication rates (21.5% to 23.3%) increased in recent years. Patients without private insurance (OR 1.7, p=.0033; OR 1.5, p=.0382), and higher comorbidity (OR 1.8, p<.0001; OR 1.5, <.0001) had an increased risk of non-routine discharge and complications, respectively. High surgical case-load reduced non-routine discharge by 30% (OR 0.7, p<.0001) and complications by 10% (OR 0.9, p<.0281). Conclusions A 41% or 178 cases per year reduction in surgical excision of acoustic neuroma cases was observed between 2001 and 2007. A possible explanation for this trend includes increased utilization of stereotactic radiosurgery. Non-routine discharge and complications after surgical excision have increased perhaps due to surgery being utilized for larger tumors.
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