The Contemporary Association of Hospital volume with Outcomes of Surgery for Vestibular Schwannoma in the United States.

BACKGROUND

Despite advancements in microsurgical technique, perioperative morbidity following resection for vestibular schwannoma (VS) remains significant. Given contemporary care paradigms, we characterized the presence of a volume-outcome relationship in a contemporary national cohort.

METHODS

The 2013-2022 Nationwide Readmissions Database was queried to identify adults undergoing VS resection. Hospitals were classified as low- (LVH) and high-volume hospitals (HVH), based on annual thresholds developed from restricted cubic spline models. Multivariable logistic regressions were subsequently utilized to evaluate the association of HVH status with outcomes of interest including major adverse events (MAE) defined as a composite of in-hospital mortality and postoperative complications.

RESULTS

Of an estimated 19,883 patients, 13,007 (65%) were treated at HVH. HVH centers were defined as those that performed at least 10 cases annually. Compared to others, HVH were younger, more commonly female, and of the highest income quartile. Following adequate risk adjustment, treatment at HVH was associated with lower odds of MAE (AOR 0.64, 95% CI 0.56-0.73), facial droop (AOR 0.59, 95% CI 0.51-0.68), dysphagia (AOR 0.59, 95% CI 0.47-0.74), and acute cerebrovascular events (AOR 0.75, 95% CI 0.56-0.98) with LVH as reference. HVH status was linked with shorter LOS (β -1.25 days, 95% CI -1.55 to -0.95), and lower odds of nonhome discharge (AOR 0.44, 95% CI 0.36-0.55).

CONCLUSION

HVH status was associated with lower odds of MAE, reduced risk of postoperative complications, and shorter length of stay. Improved policies regarding centralization and surgical expertise of VS at LVH may help enhance overall standard of care.