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National prevalence and impact of perioperative vagus nerve injury in vestibular schwannoma

Authors

  • Bryan K. Ward MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A.
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    • B.K.W.'s research efforts are in part supported by NIDCD (National Institute on Deafness and Other Communication Disorders) T32DC000027.

  • Howard W. Francis MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A.
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  • Simon R. Best MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A.
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  • Heather M. Starmer MA,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A.
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  • Lee M. Akst MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A.
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  • Christine G. Gourin MD, MPH

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A.
    • Johns Hopkins Outpatient Center, Department of Otolaryngology–Head and Neck Surgery, 601 N. Caroline Street Suite 6260, Baltimore, MD 21287

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  • Presented at the Triological Society Combined Sections Meeting, San Diego, California, U.S.A., April 20, 2012.

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Lower cranial nerve injury may be an under-reported complication of vestibular schwannoma surgery. This study aims to characterize the prevalence of complications associated with vagus nerve injury following vestibular schwannoma surgery and the impact of these complications on patient care.

Study Design:

Retrospective cross-sectional study.

Methods:

Discharge data from the Nationwide Inpatient Sample for 17,281 patients with vestibular schwannoma who underwent surgery in 2003–2008 were analyzed using cross-tabulations and multivariate regression modeling.

Results:

Dysphagia was reported in 443 cases (2.6%) and unilateral vocal fold paralysis in 115 cases (0.7%). The mean length of hospitalization was 5.3 days (95% confidence interval [CI], 4.9-5.7) and was prolonged in patients with dysphagia (mean, 11.7 days; 95% CI, 8.9-14.4) and in those with unilateral vocal fold paralysis (mean, 12.1 days; 95% CI, 7.3-16.9). Compared to patients without dysphagia, a diagnosis of dysphagia was associated with advanced comorbidity status (37.0% vs. 18.8%), central nervous system complications (39.3% vs. 15.3%), aspiration pneumonia (7.1% vs. 0.4%), and greater likelihood of requiring medical care at another facility or at home after discharge (48.5% vs. 6.6%, P < .001). Tracheostomy (3.4% vs. 0.8%) and gastrostomy tube placement (20.9% vs. 0.5%) were significantly more likely in patients with dysphagia (P < .0001). After adjusting for other variables, dysphagia, aspiration pneumonia, and tracheostomy were significantly associated with increased length of hospitalization and hospital-related costs.

Conclusions:

Although infrequently reported in this national inpatient sample, vagus nerve injury-related symptoms are associated with significantly increased length of hospitalization and costs of care.

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