Trends in Demographics, Charges, and Outcomes of Patients Undergoing Excision of Sporadic Vestibular Schwannoma

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%. 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.