Increasing Inpatient Costs and Complication Rates After Vestibular Schwannoma Resections from 1998 to 2021.

Abstract

Objective: To examine temporal trends in postoperative surgical and medical complications after vestibular schwannoma (VS) resections, and to describe changes in inpatient hospitalization costs.

Study design: Cross-sectional analysis.

Setting: National Inpatient Sample, 1998-2021.

Participants: 50,991 admissions.

Interventions: VS resection.

Main outcome measures: Surgical and medical complications after VS resection were recorded annually and trended over time. The annual average cost of inpatient hospitalization (in inflation adjusted 2024 US dollars) and length of stay were also documented for each year. Multivariate analysis was performed to determine whether subsequent calendar years were associated with changes in costs.

Results: From 1998 to 2021, the annual average number of VS resections decreased by 32.7% from 3,813 to 2,557. Rates of surgical and medical complications increased from 18.2 to 34.2% (b = 0.73 [95% CI, 0.53-0.93], p < 0.001), and from 4.3 to 7.6% (b = 0.17 [95% CI, 0.11-0.22], p < 0.001), respectively. The number of comorbidities among surgical patients increased over time, and rates of complications increased among patients with higher comorbidity scores, with 54.0% of those with ≥4 comorbidities experience a complication, compared with 28.1% of those with no comorbidities. The mean inpatient cost per admission increased from $30,922 to $45,973, which was statistically significant on multivariate regression (b = $412 [95% CI, 208-615], p < 0.001), despite a decrease in average inpatient stay from 5.4 (SE 0.5) to 4.5 (SE 0.3) days.

Conclusions: As the number of VS operations has decreased, the percentage with postoperative complications has increased, likely due to changes in patient selection as well as increasing comorbidities in operative cases. Healthcare expenditures for postoperative admissions have increased significantly over the last two decades, resulting in a roughly $15,000 increase in mean inflation-adjusted inpatient costs per postoperative admission.