Author(s)
Taral K. Jella, BA
Tara P. Menon, BS
Jazlyn Selvasingh, BA
Neha Sonthi, BS
Justin R. Shinn, MD
Affiliation(s)
Virginia Tech Carilion School of Medicine
Abstract:
Introduction: Skull base surgery is a high-acuity domain within otolaryngology requiring substantial hospital resources, yet national analyses remain limited. This study evaluates decade-long trends in approach utilization, perioperative morbidity and mortality, and healthcare efficiency for skull base surgery.
Methods: A retrospective cohort study was conducted using ACS-NSQIP (2011–2021). Patients undergoing skull base procedures were stratified into Open and Endoscopic cohorts. Trends were analyzed for operative volume, approach, and frailty (mFI-5). Primary outcomes were 30-day major complications (SSI, pneumonia, renal failure, stroke, myocardial infarction, sepsis, etc.) and mortality. Multivariable logistic regression identified independent predictors, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI).
Results: A total of 33,458 patients were identified. Open approach increased from 73.9% to 76.3% (p=0.047). Open approach independently predicted major complications (aOR 2.84, 95% CI 2.53–3.19, p<0.001). Increased frailty (1-point increase in mFI-5) was associated with adverse outcomes (aOR 1.70, 95% CI 1.62–1.79, p<0.001). The adjusted rate of major complications remained stable (p=0.12). Efficiency improved, with mean LOS decreasing from 7.0 to 5.6 days (p=0.049).
Conclusions: Morbidity and mortality of skull base procedures remained stable, and efficiency has improved, reflected by a 20% reduction in average LOS. Open approaches remain predominant and have nearly 3-fold higher complication risk than endoscopic techniques, independent of frailty. Enhanced recovery protocols may drive efficiency gains despite the constant physiological burden of surgery.