Increased Costs and Complication Rates in Vestibular Schwannoma Resections for Neurofibromatosis Type 2.

Abstract

Objective: To characterize inpatient costs and complication rates in sporadic and neurofibromatosis type 2 (NF2) patients undergoing resection of vestibular schwannoma (VS).

Design: Cross-sectional analysis.

Setting: National Inpatient Sample, 1998-2021.

Participants: A total of 52,623 inpatient admissions after VS resection.

Interventions: Resection of VS.

Main outcomes and measures: Patient- and hospital-level demographics of admissions following resection of VS, as well as the frequency of postoperative medical and surgical complications, were tabulated. We evaluated the average cost of admission and compared these outcomes between sporadic and NF2 patients. Multivariate analysis was performed to determine whether NF2 admissions had increased costs and lengths of stay.

Results: A total of 51,459 and 1,164 resections were recorded for sporadic and NF2 patients, respectively. Patients with NF2 were younger (mean age 35.3 vs. 51.1 years) and more likely insured by Medicaid (12.8% vs. 5.4%). The average cost for NF2 admissions was $49,141 (95% CI, 42,527-55,754), relative to sporadic tumors at $38,204 (95% CI, 36,408-40,000). NF2 patients had increased rates of surgical complications, including facial nerve dysfunction (31.7% vs. 17.3%), dysphagia (8.8% vs. 2.8%), aspiration pneumonia (3.4% vs. 0.6%), and sepsis (1.8% vs. 0.4%), which were associated with increased hospital costs. NF2 was not independently associated with increased inpatient hospital costs after controlling for patient factors and complications ($3,977 [95% CI, -$111 to 8,066], p = 0.06).

Conclusions: Relative to sporadic VS admissions, resections in NF2 patients are associated with significantly increased hospital costs, primarily due to increased rates of postoperative surgical, central nervous system-related, and medical complications.