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UC Irvine UC Irvine Previously Published Works UC Irvine UC Irvine Previously Published Works Title Postoperative Complications and Readmission Rates Following Surgery for Cerebellopontine Angle Schwannomas. Permalink https://escholarship.org/uc/item/8b34h48g Journal Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 37(9) ISSN 1531-7129 Authors Mahboubi, Hossein Haidar, Yarah M Moshtaghi, Omid et al. Publication Date 2016-10-01 DOI 10.1097/mao.0000000000001178 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Otology & Neurotology 37:1423–1427 ß 2016, Otology & Neurotology, Inc. Postoperative Complications and Readmission Rates Following Surgery for Cerebellopontine Angle Schwannomas ÃHossein Mahboubi, ÃYarah M. Haidar, ÃOmid Moshtaghi, ÃKasra Ziai, ÃYaser Ghavami, ÃMarlon Maducdoc, ÃHarrison W. Lin, and ÃyHamid R. Djalilian ÃDivision of Neurotology and Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery; and yDepartment of Biomedical Engineering, University of California, Irvine, California Objective: To investigate the 30-day postoperative compli- wound dehiscence (11 patients, 2.7%), sepsis (10 patients, cation, readmission, and reoperation rates following surgery 2.5%), blood loss (nine patients, 2.2%), and deep vein for cerebellopontine angle (CPA) schwannomas. thrombosis (DVT; seven patients, 1.7%). Mortality occurred Study Design: Cross-sectional analysis. in four patients (1.0%). The complication rate was statisti- Setting: National surgical quality improvement program cally higher in patients with comorbidities versus those dataset (NSQIP) 2009 through 2013. without (10.2% versus 4.1%, p ¼ 0.04). Patients with compli- Patients: All surgical cases with an International Classification cations were more likely to undergo reoperation (2.5% with of Diseases, 9th edition, Clinical Modification (ICD-9-CM) versus 4.1% without, p ¼ 0.001). Unplanned readmissions diagnosis code of 225.1, benign neoplasms of cranial nerves, occurred in 41 cases (10.1%) and reoperations occurred in and one of the following current procedural terminology (CPT) 23 patients (5.7%). codes, were included: 61616, 61526, 61530, and 61520. Conclusions: Most common NSQIP-tracked complications in Intervention(s): Surgical resection as indicated by the CPT excision of CPA neoplasms are infections, sepsis, blood loss, codes above. and deep vein thrombosis (DVT). Further, investigation of Main Outcome Measure(s): Demographics, comorbidities, patients with unplanned readmission and reoperation are 30-day postoperative complications, readmission rate, and warranted. Neurotologists need to take an active role in the reoperation rate. data to be gathered in the NSQIP database as it relates to Results: Overall, 404 cases were identified, of which 42.6% vestibular schwannomas. Key Words: Acoustic neuroma— were men. The average age was 51 years. Comorbidities Cerebellopontine angle neoplasm—Complications—CPA were present in 45.3%. NSQIP-tracked complications tumors—NSQIP—Quality of care—Vestibular schwannoma. occurred in 9.7% of patients. Most common complications were wound infections including surgical-site infection and Otol Neurotol 37:1423–1427, 2016. Cerebellopontine angle (CPA) neoplasms consist of a options for VSs, recent studies have demonstrated declin- variety of tumors that comprise less than 10% of intra- ing surgical volume, likely attributable to the increasing cranial tumors. Approximately, 70 to 90% of these use of stereotactic radiosurgery and observation (5–7). tumors are vestibular schwannomas (VS) (1). Other less Despite this trend, surgery continues to be the most common lesions include meningiomas, hemangiopericy- commonly used treatment modality with approximately tomas, epidermoids, lipomas, paragangliomas, and 50% of VSs treated with surgical excision (8). Post- arachnoid cysts (2). VSs are slow growing tumors of operative complications depend on surgical approach, the eighth cranial nerve originating from the Schwann tumor size, and surgeon experience, and have been cells with an incidence rate of approximately 1 in reported to occur in 28.2 to 45% of patients (9–11). 100,000 (3–5). While surgical resection, stereotactic With the advent of quality metrics and pay for per- radiosurgery, and observation are all viable treatment formance in medicine, particularly in surgical care, there has been an increased focus on quality improvement and its measurement methods. The Centers for Medicare and Address correspondence and reprint requests to Hamid R. Djalilian, M.D., Division of Neurotology and Skull Base Surgery, Department of Medicaid Services have developed various performance Otolaryngology–Head and Neck Surgery, University of California initiatives aimed at rewarding hospitals and physicians Irvine, 19182 Jamboree Road, Otolaryngology-5386, Irvine, CA for high quality of care (12). The National Surgical 92697; E-mail: [email protected] Quality Improvement Program (NSQIP) is a program Presented at the American Neurotology Society’s 51st Annual Spring Meeting at COSM, May 20–22, 2016, Chicago, IL. designed and performed by the American College of The authors disclose no conflicts of interest. Surgeons (ACS), which defines quality of care in surgery DOI: 10.1097/MAO.0000000000001178 and is focused on 30-day postoperative complications, 1423 Copyright © 2016 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited. 1424 H. MAHBOUBI ET AL. unplanned readmissions, and unplanned reoperations. TABLE 1. List of CPT codes related to excision of Studies have shown benefits of enrollment in the NSQIP cerebellopontine angle tumors program to improve surgical morbidity and mortality CPT Code Description (13). Despite the heightened awareness regarding quality 61520 Craniectomy for excision of brain tumor, infratentorial or metrics, there is little published in the field of neuro- posterior fossa; cerebellopontine angle tumor tology. As the healthcare system experiences a gradual 61526 Craniectomy, bone flap craniotomy, transtemporal shift towards incentives for quality and performance, it is (mastoid) for excision of cerebellopontine angle tumor vital to investigate the quality metrics collected and 61616 Resection or excision of neoplastic, vascular or infectious evaluated by NSQIP and Centers for Medicare and lesion of base of posterior cranial fossa, jugular foramen, foramen magnum, or C1–C3 vertebral bodies; Medicaid Services. intradural, including dural repair, with or without graft In this study, we aimed to investigate the 30-day 61530 Craniectomy, bone flap craniotomy, transtemporal postoperative complications, readmissions, and reopera- (mastoid) for excision of cerebellopontine angle tumor; tion rates following surgery for CPA schwannomas, and combined with middle/posterior fossa craniotomy/ by investigating the NSQIP data from 2009 to 2013. craniectomy CPT indicates current procedural terminology. MATERIALS AND METHODS Data Source occurrence likely related to the principal surgical procedure The NSQIP collects data on the outcomes of surgical inter- within 30 days of the procedure. The last 2 years analyzed, 2012 ventions across the United States. The data collected by this and 2013, collected associated CPT codes and ICD-9-CM codes program is accessible through annual datasets released by the with each reoperation. The previous years (2009–2011) only ACS and used to monitor quality of surgical care and compli- reported whether reoperation occurred but did not specify what cations within and between hospitals. The ACS NSQIP collects type of surgery was performed. data on over 300 variables, including preoperative risk factors, intraoperative variables, and 30-day postoperative mortality Statistical Analyses and morbidity outcomes for patients undergoing major surgical Data distribution of continuous variables was examined for procedures in both the inpatient and outpatient setting. Patient normality. Mean Æ standard deviation (SD) was calculated for diagnosis is captured through the International Classification of normal distributions and median for skewed distributions. Diseases, 9th edition, Clinical Modification (ICD-9-CM) diag- Frequency and percentages were reported for binary or categ- nosis codes and procedures performed are captured through orical variables. Chi-square test was used to evaluate associated current procedural terminology (CPT) codes. Furthermore, factors with complications and reoperations. The PASW Stat- information regarding data collection instruments, variable istics 18.0 (SPSS, Inc., Chicago, IL) was used for all data definitions, and quality control is available elsewhere (14). analyses. A p value of less than 0.05 was considered significant. The datasets did not contain identifiable patient information and are available by request and considered exempt by our RESULTS institutional review board. Data use agreement was signed before obtaining the data. The 2009 through 2013 datasets combined contained 2,337,145 cases collected from 237 hospitals in 2009, Variables and Definitions 258 hospitals in 2010, 315 hospitals in 2011, 374 hos- The NSQIP datasets of 2009 through 2013 were obtained and merged. All surgical cases with an ICD-9-CM diagnosis code of pitals in 2012, and 435 hospitals in 2013. Of these, 404 225.1, benign neoplasms of cranial nerves, which listed one of cases (0.02%) met our inclusion and exclusion criteria the following CPT codes as their
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