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Trends in demographics, charges, and outcomes of patients undergoing excision of sporadic vestibular schwannoma

  • Author(s): Ahmed, OH
  • Mahboubi, H
  • Lahham, S
  • Pham, C
  • Djalilian, HR
  • et al.
Abstract

Objective. To assess demographics, charges, and outcome measures by temporal and volume analysis in the treatment of vestibular schwannoma. Design. Cross-sectional analysis. Setting, Subjects, and Methods. The California Hospital Inpatient Discharge Databases from 1996 to 2010. Results. A total of 6545 cases from 1996 to 2010 were identified. Of these, 86.2% occurred at high-volume centers (HVCs), and the number of annual cases decreased by 28.5% over the study period. Patients presenting for surgery were increasingly younger, non-Caucasian, and likely to have comorbidities. Total charges significantly increased over time (P <.001), with the median total charge in 2006-2010 being $91,338 compared with $38,607.92 in 1996-2000 after adjusting for inflation. Routine discharges (home or residence) were more likely at HVCs (odds ratio [OR] 5.48, P < .001) and less likely if patients had Medicaid (Medi-Cal; OR 0.51, P = .002) or Medicare (OR 0.55, P = .022), were 65 years or older (OR 0.56, P = .025), or had comorbidities (OR 0.54, P <.001). Shorter hospital stays were more likely at HVCs (OR 3.77, P < .001) and less likely if patients had Medicaid (OR 0.36, P < .001) or comorbidities (OR 0.61, P < .001). Lesser total charges were more likely at HVCs (OR 2.12, P = .002) and less likely if patients had comorbidities (OR 0.70, P <.001). Mortality was less likely at HVCs (OR 0.10, P = .011). Conclusion. The profile of patients undergoing vestibular neuroma excision is changing. Surgical volume is decreasing, suggesting a trend toward more conservative management or stereotactic radiation. Patients are best served at HVCs, where routine discharges, shorter length of stay, decreased mortality, and lower total charges are more likely. © 2013 American Academy of Otolaryngology - Head and Neck Surgery Foundation.

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