SURG-14. OPERATIVE MORTALITY RATES OF ACOUSTIC NEUROMA SURGERY: A NATIONWIDE CANCER DATABASE ANALYSIS

Abstract

Optimal management of acoustic neuroma (AN) involves choosing between three treatment modalities: microsurgical excision, radiation (fractionated stereotactic radiotherapy or stereotactic radiosurgery), or observation with serial imaging. The in-hospital mortality rate of surgery for AN in the United States is 0.5% (McClelland et al., 2011). 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 2004-2013 identified AN patients receiving surgery. Multivariate logistic regression assessed the mortality of surgery at 30 days postoperatively, adjusting for several variables including patient age, race, sex, income, geographic region, primary payer for care, tumor size, and medical comorbidities. A total of 10,136 patients received surgery as solitary treatment for AN. Mortality at 30 days postoperatively occurred in 49 patients (0.5%). Mortality at 60 and 90 days postoperatively occurred in 67 (0.7%) and 81 (0.8%) patients, respectively. At 30 days postoperatively, only a Charlson/Deyo score of 2 (OR=6.6;95%CI=2.6-16.6;p=0.002) was predictive of increased mortality. No other patient demographic, including African-American race (OR=1.9;95%CI=0.7-5.1;p=0.23), minimum age of 65 (OR=2.2;95%CI=0.8-5.6;p=0.11) or government insurance (OR=6.2;95%CI=2.0-18.9;p=0.06) was predictive of 30-day operative mortality. The 30-day mortality rate following surgery for AN is 1/200 (0.5%), which is equivalent to the established in-hospital operative mortality rate, and is 2.5 times higher than the cumulative assessment from single-center studies (Sughrue et al., 2011). 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 prior to 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.