Operative Mortality Rates of Acoustic Neuroma Surgery: A National Cancer Database Analysis.

Abstract

Optimal acoustic neuroma (AN) management involves choosing between three treatment modalities: microsurgical excision, radiation, or observation with serial imaging. The reported in-hospital mortality rate of surgery for AN in the United States is 0.5%. However, there has yet to be a nationwide examination of the AN surgery mortality rate encompassing the period beyond initial hospital discharge. The National Cancer Data Base (NCDB) from 2004 to 2013 identified AN patients receiving surgery. Multivariate logistic regression assessed 30-day operative mortality, adjusting for several variables including patient age, race, sex, income, geographic region, primary payer for care, tumor size, and medical comorbidities. Ten thousand one hundred thirty six patients received surgery as solitary treatment for AN. Mortality at 30 days postoperatively occurred in 49 patients (0.5%); only a Charlson/Deyo score of 2 (odds ratio [OR] = 6.6;95% confidence interval [CI] = 2.6-16.6; p = 0.002) was predictive of increased mortality. No other patient demographic including African-American race, minimum age of 65 or government insurance was predictive of 30-day operative mortality. The 30-day mortality rate following surgery for AN is 1 of 200 (0.5%), equivalent to the established in-hospital operative mortality rate, and 2.5 times higher than the cumulative assessment from single-center studies. No patient demographic other than increasing medical comorbidities reached significance in predicting 30-day operative mortality. The nearly identical rates of 30-day and in-hospital mortality from separate nationwide analyses indicate that nearly all of the operative mortality occurs before initial postoperative discharge from the hospital. This mortality rate provides a framework for comparing the true risks and benefits of surgery versus radiation or observation for AN.