J Neurol Surg B Skull Base 2020; 81(05): 546-552
DOI: 10.1055/s-0039-1692478
Original Article

Risk Factors for 30-Day Non-Neurological Morbidity and Cerebrospinal Fluid Leak in Patients Undergoing Surgery for Vestibular Schwannoma

Yaroslav Gelfand
1  Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Ce/Snter/Albert Einstein College of Medicine, Bronx, New York, Unites States
,
2  Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, United States
,
Naomi Berezin
3  Department of Surgery, Montefiore Medical Center, Bronx, New York, United States
,
Jonathan P. Nakhla
4  Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, United States
,
Rafael De la Garza-Ramos
1  Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Ce/Snter/Albert Einstein College of Medicine, Bronx, New York, Unites States
,
Vijay Agarwal
1  Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Ce/Snter/Albert Einstein College of Medicine, Bronx, New York, Unites States
› Author Affiliations
Funding No funds were received in support of this work.

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.

Disclaimer

The manuscript submitted does not contain information about medical device(s)/drug(s).




Publication History

Received: 24 February 2019

Accepted: 11 May 2019

Publication Date:
21 June 2019 (online)

Georg Thieme Verlag KG
Stuttgart · New York