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Acta Neurochirurgica
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Acta Neurochirurgica
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Applicability of contemporary quality indicators in vestibular surgery—do they accurately measure tumor inherent postoperative complications of vestibular schwannomas?

Authors: Stephanie Schipmann; Sebastian Lohmann; Bilal Al Barim; Eric Suero Molina; Michael Schwake; Özer Altan Toksöz; Walter Stummer;

Applicability of contemporary quality indicators in vestibular surgery—do they accurately measure tumor inherent postoperative complications of vestibular schwannomas?

Abstract

Abstract Background Due to rising costs in health care delivery, reimbursement decisions have progressively been based on quality measures. Such quality indicators have been developed for neurosurgical procedures, collectively. We aimed to evaluate their applicability in patients that underwent surgery for vestibular schwannoma and to identify potential new disease-specific quality indicators. Methods One hundred and three patients operated due to vestibular schwannoma were subject to analysis. The primary outcomes of interest were 30-day and 90-day reoperation, readmission, mortality, nosocomial infection and surgical site infection (SSI) rates, postoperative cerebral spinal fluid (CSF) leak, facial, and hearing function. The secondary aim was the identification of prognostic factors for the mentioned primary outcomes. Results Thirty-day (90-days) outcomes in terms of reoperation were 10.7% (14.6%), readmission 9.7% (13.6%), mortality 1% (1%), nosocomial infection 5.8%, and SSI 1% (1%). A 30- versus 90-day outcome in terms of CSF leak were 6.8% vs. 10.7%, new facial nerve palsy 16.5% vs. 6.1%. Hearing impairment from serviceable to non-serviceable hearing was 6.8% at both 30- and 90-day outcome. The degree of tumor extension has a significant impact on reoperation (p < 0.001), infection (p = 0.015), postoperative hemorrhage (p < 0.001), and postoperative hearing loss (p = 0.026). Conclusions Our data demonstrate the importance of entity-specific quality measurements being applied even after 30 days. We identified the occurrence of a CSF leak within 90 days postoperatively, new persistent facial nerve palsy still present 90 days postoperatively, and persisting postoperative hearing impairment to non-serviceable hearing as potential new quality measurement variables for patients undergoing surgery for vestibular schwannoma.

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Keywords

Original Article - Brain Tumors, Facial Paralysis, Neuroma, Acoustic, Prognosis, Neurosurgical Procedures, Postoperative Complications, Treatment Outcome, Hearing, Humans, Facial Paralysis/epidemiology [MeSH] ; Original Article - Brain Tumors ; Brain Tumors ; Postoperative Complications/epidemiology [MeSH] ; Neuroma, Acoustic/complications [MeSH] ; Quality Indicators, Health Care/statistics ; Quality indicator ; Readmission ; Hearing [MeSH] ; Postoperative Complications/etiology [MeSH] ; Acoustic neurinoma ; Neurosurgical Procedures/standards [MeSH] ; Vestibular schwannoma ; Reoperation ; Humans [MeSH] ; Treatment Outcome [MeSH] ; Neuroma, Acoustic/surgery [MeSH] ; Retrospective Studies [MeSH] ; Facial nerve palsy ; Postoperative Complications/surgery [MeSH] ; Neurosurgical Procedures/methods [MeSH] ; Facial Paralysis/etiology [MeSH] ; Prognosis [MeSH] ; Surgical site infection ; Neurosurgical Procedures/adverse effects [MeSH], Quality Indicators, Health Care, Retrospective Studies

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
4
Top 10%
Average
Average
Green
hybrid