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Otology/Neurotology

Association of Comorbidities and Postoperative Outcomes After Vestibular Schwannoma Resection

Tuesday, October 3, 2023
8:48 AM - 8:54 AM East Coast USA Time
Location: 104BC

    Co-Author(s)

  • AG

    Alejandro Garcia, MD

    Resident
    University of Iowa
    Boston, MA, United States

    • Presenting Author(s)

  • Afash Haleem, BA

    MD Candidate
    Rutgers New Jersey Medical School
    Dayton, NJ, United States

    • Co-Author(s)

  • MB

    Mustafa G. Bulbul, MD MPH

    Resident
    West Virginia University
    Morgantown, WV, United States

  • Samantha M. Shave, BS

    Medical Student
    Rutgers - Robert Wood Johnson Medical School
    Jackson Township, New Jersey, United States

    • Senior Author(s)

  • Daniel J. Lee, MD

    Associate Professor, HMS
    Massachusetts Eye and Ear Infirmary (MEEI)
    Boston, MA, United States

Disclosure(s):
Afash Haleem, BA: No relevant relationships to disclose.
Introduction: The modified frailty index (mFI-5) is a comorbidity-based risk stratification tool that has been validated in patients undergoing a number of surgical procedures. This study investigates the association between mFI-5 score and vestibular schwannoma (VS) surgery complications, thus predicting risk of complication for future VS resection patients.

Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent VS resection between 2005-2018. The mFI-5 was calculated for each patient by assigning one point for each of the following comorbidities: DM, hypertension, CHF, COPD, and dependent health status. Univariate and multivariable analyses were conducted to determine associations between mFI-5 score and postoperative complications.

Results: 2669 patients undergoing VS resection were identified. They were stratified into the following groups: mFI=0 (n=1676 [62.7%], mFI=1 (n=244 [9.14%]), and mFI of 2 or greater (n=211 [7.9%]). In a multivariable analysis controlling for significantly different comorbidities (American Society of Anesthesiology physical status, obesity, smoking, dyspnea), patients with mFI of 2 or greater tended to have a greater risk of any medical complication (OR=1.68, 95% CI: 1.02 - 2.78) and surgical complication (OR=1.81, 95% CI: 1.01 - 3.29). The main medical perioperative complications following vestibular schwannoma surgery associated with a higher mFI was pneumonia (OR=3.40, 95% CI: 1.44 - 8.01). The main surgical perioperative complications were reintubation (OR=4.05, 95% CI: 1.64-10.02) and need for ventilation for >48 hours (OR=2.42, 95% CI: 1.08-5.41).

Conclusions: Our study suggests that patients with VS and higher number of comorbidities have a greater risk of medical and surgical perioperative complications. The mFI-5 score can be used before surgery to stratify the risk of a patient prior to VS resection to determine the risk of specific complications.