Predictors of Prolonged Hospital Stay After Microsurgery for Vestibular Schwannoma: Analysis of a Decade of Data.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-12-01 Epub Date: 2024-09-06 DOI:10.1097/MAO.0000000000004320

Mohamed A Aboueisha, Regan Manayan, Kevin Tie, Peter P Issa, Mohamed A Al-Hamtary, Victoria Huang, James G Naples

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引用次数: 0

Abstract

Importance: Microsurgical resection is one of the treatments for vestibular schwannomas (VS). While several factors have been linked to increased length of stay (LOS) for VS patients undergoing microsurgery, a better understanding of these factors is important to provide prognostic information for patients.

Objective: Determine predictors of increased LOS for VS patients undergoing microsurgical resection.

Design: Retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2010 to 2020.

Setting: Database review.

Participants: All patients who underwent microsurgery (CPT codes 61520, 61526/61596) for the management of vestibular schwannoma (ICD9 and ICD10 codes 225.1, D33.3) were included.

Main outcomes and measures: Analyzing perioperative factors that can predict prolonged hospital stay.

Results: A total of 2096 cases were identified and 1,188 (57%) of these patients were female. The mean age was 51.0 ± 14.0 years. Factors contributing to prolonged LOS included African American race (OR = 2.11, 95% CI: 1.32-3.36, p = 0.002), insulin-dependent diabetes mellitus (OR = 2.12, 95% CI: 1.09-4.4.11, p = 0.026), hypertension (OR = 1.26, 95% CI: 1-1.58, p = 0.046), functional dependency (OR = 5.22, 95% CI: 2.31-11.79, p = 0.001), prior steroid use (OR = 1.96, 95% CI: 1.18-3.15, p = 0.009), ASA class III (OR = 2.06, 95% CI: 1.18-3.6, p < 0.011), ASA class IV (OR = 6.34, 95% CI: 2.62-15.33, p < 0.001), and prolonged operative time (OR = 2.14, 95% CI: 1.76-2.61). Microsurgery by a translabyrinthine (TL) approach compared to a retrosigmoid (RSG) approach had lower odds of prolonged LOS (OR = 0.67, 95% CI: 0.54-0.82, p < 0.001). In a separate analysis regarding patients receiving reoperation, operative time was the only predictor of prolonged LOS (OR = 2.77, 95% CI: 1.39-5.53, p = 0.004.).

Conclusions and relevance: Our analysis offers an analysis of the factors associated with a prolonged LOS for the surgical management of VS. By identifying healthcare disparities, targeting modifiable factors, and applying risk stratification based on demographics and comorbidities, we can work toward reducing disparities in LOS and enhancing patient outcomes.

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前庭许旺瘤显微手术后住院时间延长的预测因素：十年数据分析。

重要性：显微手术切除是治疗前庭分裂瘤（VS）的方法之一。虽然有几个因素与接受显微手术的 VS 患者的住院时间（LOS）延长有关，但更好地了解这些因素对于为患者提供预后信息非常重要：确定接受显微手术切除的 VS 患者住院时间延长的预测因素：利用美国外科学院国家外科质量改进计划（ACS-NSQIP）数据库对2010年至2020年的数据进行回顾性分析：数据库回顾：纳入所有接受显微手术（CPT代码61520、61526/61596）治疗前庭分裂瘤（ICD9和ICD10代码225.1、D33.3）的患者：分析可预测住院时间延长的围手术期因素：结果：共发现 2096 例病例，其中 1188 例（57%）患者为女性。平均年龄为 51.0 ± 14.0 岁。导致住院时间延长的因素包括非裔美国人（OR = 2.11，95% CI：1.32-3.36，P = 0.002）、胰岛素依赖型糖尿病（OR = 2.12，95% CI：1.09-4.4.11，P = 0.026）、高血压（OR = 1.26，95% CI：1-1.58，P = 0.046）、功能依赖性（OR = 5.22，95% CI：2.31-11.79，p = 0.001）、曾使用类固醇（OR = 1.96，95% CI：1.18-3.15，p = 0.009）、ASA III 级（OR = 2.06，95% CI：1.18-3.6，p < 0.011）、ASA IV 级（OR = 6.34，95% CI：2.62-15.33，p < 0.001）和手术时间延长（OR = 2.14，95% CI：1.76-2.61）。采用迷走神经经（TL）入路进行显微手术与采用回盲部（RSG）入路进行显微手术相比，LOS延长的几率更低（OR = 0.67，95% CI：0.54-0.82，P < 0.001）。在对接受再次手术的患者进行的单独分析中，手术时间是唯一能预测患者住院时间延长的因素（OR = 2.77，95% CI：1.39-5.53，p = 0.004）：我们的分析提供了与 VS 手术治疗 LOS 延长相关的因素分析。通过识别医疗保健差异、针对可改变的因素以及根据人口统计学和合并症进行风险分层，我们可以努力减少 LOS 的差异并改善患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.