Frailty, Surgical Time, and Surgical Complications Increase Length of Stay Following Large Vestibular Schwannoma Resection.

Abstract

Patients with large vestibular schwannomas (VS) are at higher risk for adverse outcomes following microsurgical resection. This study aims to identify clinical and radiographic factors that may be predictive of adverse outcomes. Retrospective chart review. Academic tertiary care center. A chart review of patients with Koos III or IV VS from 2016 to 2020 was conducted. Demographics, preoperative 11-item modified frailty index (mFI-11), and surgical information were collected: preoperative Koos score and the total tumor volume (TV) on T2 MRI sequences. Preoperative and postoperative tumor characteristics, symptoms, and House-Brackmann (HB) facial nerve function were assessed. Outcomes included increased length of stay (LOS; defined as >4 days), nonhome discharge (NHD), and surgical complications. Statistical analysis was performed with SPSS version 29. In total, 79 patients were identified; 54% were female and 86% were white. On univariable binary logistic regression analysis, factors associated with increased LOS included surgical time, TV, frailty (measured by mFI-11), and any surgical complication. On multivariable analysis, only increased frailty (odds ratio [OR]: 12.99; 95% CI: 2.06-81.91), surgical time (OR: 1.01; 95% CI: 1.00-1.02), and having a surgical complication (OR: 5.95; 95% CI: 1.48-23.87) were independent predictors of LOS. The only independent predictor of NHD was VP shunt placement after surgery (OR: 9.71; 95% CI: 1.18-80.02). There were no other independent predictors of LOS, NHD, or surgical complications. Frailty, as measured by increased mFI-11, surgical time, and surgical complications were independent predictors of increased LOS. VP shunt placement after surgery was an independent predictor of NHD.