Author(s)
Zachary G Schwam, MD
Rocco Ferrandino, MD
Vivian Z Kaul, MD
Maura K Cosetti, MD
George B Wanna, MD
Affiliation(s)
Mount Sinai
Abstract:
Objectives: To determine the risk factors for unanticipated readmission and prolonged index admission aftervestibular schwannoma surgery.Study design: Retrospective cohort study.Setting: Large, national database.Patients: Those undergoing surgery for vestibular schwannoma were identified in the Nationwide ReadmissionsDatabase (2013-2014).Main outcome measures: readmission rate, length of stayResults: There were 4,586 cases identified. The overall unanticipated readmission rate was 7.5%, and 7.9% had aprolonged length of stay (LOS) of >8 days. Mean and median LOS were 4.48 and 4.00 days, respectively, and>90% of patients were discharged after 7 days. Disposition to a facility occurred in 6.4% of cases. ModifiedCharlson score of 1 (odds ratio [OR] 1.60, p=.001), large hospital size (OR 0.37, p<.001), and prolonged LOS (OR2.42, p<.001) were independently associated with unintended readmission. Variables independently associated withprolonged index admission include high-volume facility (OR 0.33, p<.001), disposition to a facility (OR 10.06,p<.001), and insurance consisting of Medicaid (OR 3.96, p<001) or none (OR 6.90, p<.001). The most commonreadmission diagnoses included “other nervous system complications” (2.8%), “other postoperativeinfection” (1.3%), meningitis (1.2%), and cerebrospinal fluid leak (1.2%).Conclusions: Unanticipated readmission and prolonged LOS following vestibular schwannoma surgery arecommon, with varied sociodemographic, hospital, and patient factors independently associated with each. Furtherstudies are needed to investigate targeted interventions aimed at minimizing readmission and prolonged LOSusing the factors outlined above.Learning Objective: To identify independent risk factors for unintended readmission and prolonged length ofstay in patients undergoing vestibular schwannoma resection.Define Professional Practice Gap & Educational Need: 1. Lack of awareness in independent risk factors forreadmission following hospitalization for vestibular schwannoma resection. 2. Lack of awareness ofindependent risk factors for prolonged hospitalization after vestibular schwannoma resection. Desired Result: We hope that neurotologic surgeons who perform vestibular schwannoma resection will use therisk factors for readmission and prolonged length of stay to predict outcomes for their own patients and targetinterventionable variables.Level of Evidence - Level IV - Historical cohort or case-control studiesIndicate IRB or IACUC Approval: Exempt