Long-term Effects of Conservative Management of Vestibular Schwannoma on Dizziness, Balance, and Caloric Function,
Kathrin Skorpa Nilsen, MD, Morten Lund-Johansen, MD, PhD, Stein Helge Glad Nordahl, MD, PhD, Monica Finnkirk, BSc, Frederik Kragerud Goplen, MD, PhD
https://doi.org/10.1177/0194599819860831 | First Published July 16, 2019
Abstract
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Objectives
To study the development of dizziness, caloric function, and postural sway during long-term observation of untreated vestibular schwannoma patients.
Study Design
Retrospective review of a prospectively maintained longitudinal cohort.
Setting
Tertiary referral hospital.
Subjects and Methods
Patients with vestibular schwannoma undergoing wait-and-scan management were included—specifically, those who did not require treatment during a minimum radiologic follow-up of 1 year. Baseline data and follow-up included magnetic resonance imaging, posturography, bithermal caloric tests, and a dizziness questionnaire. Main outcomes were prevalence of moderate to severe dizziness, canal paresis, and postural instability at baseline and follow-up, as compared with McNemar’s test.
Results
Out of 433 consecutive patients with vestibular schwannoma, 114 did not require treatment during follow-up and were included. Median radiologic follow-up was 10.2 years (interquartile range, 4.5 years). Age ranged from 31 to 78 years (mean, 59 years; SD, 10 years; 62% women). Median tumor volume at baseline was 139 mm3 (interquartile range, 314 mm3). This did not change during follow-up (P = .446). Moderate to severe dizziness was present in 27% at baseline and 19% at follow-up (P = .077). Postural unsteadiness was present in 17% at baseline and 21% at follow-up (P = .424). Canal paresis was present in 51% at baseline and 56% at follow-up (P = .664).
Conclusions
There was no significant change in the prevalence of dizziness, postural sway, or canal paresis during conservative management of vestibular schwannoma, while tumor volume remained unchanged. This indicates a favorable prognosis in these patients with regard to vestibular symptoms.
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Does Surgical Volume and Complexity Affect Cost and Mortality in Otolaryngology–Head and Neck Surgery?
Andrew J. Redmann, MD, Sonia N. Yuen, MD, Douglas VonAllmen, MD, Adam Rothstein, MHA, CCRP, Alice Tang, MD, Joseph Breen, MD, Ryan Collar, MD, MBA
https://doi.org/10.1177/0194599819861524 | First Published July 16, 2019
Abstract
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Objectives
(1) To evaluate whether admission volume and case complexity are associated with mortality rates and (2) evaluate whether admission volume and case complexity are associated with cost per admission.
Study Design
Retrospective case series.
Setting
Tertiary academic hospital.
Subjects and Methods
The Vizient database was queried for inpatient admissions between July 2015 and March 2017 to an otolaryngology–head and neck surgery service. Data collected included admission volume, length of stay, intensive care unit (ICU) status, complication rates, case mix index (CMI), and cost data. Regression analysis was performed to evaluate the relationship between cost, CMI, admission volume, and mortality rate.
Results
In total, 338 hospitals provided data for analysis. Mean hospital admission volume was 182 (range, 1-1284), and mean CMI was 1.69 (range, 0.66-6.0). A 1-point increase in hospital average CMI was associated with a 40% increase in odds for high mortality. Admission volume was associated with lower mortality, with 1% lower odds for each additional case. A 1-point increase in CMI produces a $4624 higher total cost per case (95% confidence interval, $4550-$4700), and for each additional case, total cost per case increased by $6.
Conclusion
For otolaryngology inpatient services at US academic medical centers, increasing admission volume is associated with decreased mortality rates, even after controlling for CMI and complication rates. Increasing CMI levels have an anticipated correlation with higher total costs per case, but admission volume is unexpectedly associated with a significant increase in average cost per case.
Kathrin Skorpa Nilsen, MD, Morten Lund-Johansen, MD, PhD, Stein Helge Glad Nordahl, MD, PhD, Monica Finnkirk, BSc, Frederik Kragerud Goplen, MD, PhD
https://doi.org/10.1177/0194599819860831 | First Published July 16, 2019
Abstract
Hide Preview
Objectives
To study the development of dizziness, caloric function, and postural sway during long-term observation of untreated vestibular schwannoma patients.
Study Design
Retrospective review of a prospectively maintained longitudinal cohort.
Setting
Tertiary referral hospital.
Subjects and Methods
Patients with vestibular schwannoma undergoing wait-and-scan management were included—specifically, those who did not require treatment during a minimum radiologic follow-up of 1 year. Baseline data and follow-up included magnetic resonance imaging, posturography, bithermal caloric tests, and a dizziness questionnaire. Main outcomes were prevalence of moderate to severe dizziness, canal paresis, and postural instability at baseline and follow-up, as compared with McNemar’s test.
Results
Out of 433 consecutive patients with vestibular schwannoma, 114 did not require treatment during follow-up and were included. Median radiologic follow-up was 10.2 years (interquartile range, 4.5 years). Age ranged from 31 to 78 years (mean, 59 years; SD, 10 years; 62% women). Median tumor volume at baseline was 139 mm3 (interquartile range, 314 mm3). This did not change during follow-up (P = .446). Moderate to severe dizziness was present in 27% at baseline and 19% at follow-up (P = .077). Postural unsteadiness was present in 17% at baseline and 21% at follow-up (P = .424). Canal paresis was present in 51% at baseline and 56% at follow-up (P = .664).
Conclusions
There was no significant change in the prevalence of dizziness, postural sway, or canal paresis during conservative management of vestibular schwannoma, while tumor volume remained unchanged. This indicates a favorable prognosis in these patients with regard to vestibular symptoms.
Full Text
PDF Download
|
Permissions
Original Research
No Access
Does Surgical Volume and Complexity Affect Cost and Mortality in Otolaryngology–Head and Neck Surgery?
Andrew J. Redmann, MD, Sonia N. Yuen, MD, Douglas VonAllmen, MD, Adam Rothstein, MHA, CCRP, Alice Tang, MD, Joseph Breen, MD, Ryan Collar, MD, MBA
https://doi.org/10.1177/0194599819861524 | First Published July 16, 2019
Abstract
Hide Preview
Objectives
(1) To evaluate whether admission volume and case complexity are associated with mortality rates and (2) evaluate whether admission volume and case complexity are associated with cost per admission.
Study Design
Retrospective case series.
Setting
Tertiary academic hospital.
Subjects and Methods
The Vizient database was queried for inpatient admissions between July 2015 and March 2017 to an otolaryngology–head and neck surgery service. Data collected included admission volume, length of stay, intensive care unit (ICU) status, complication rates, case mix index (CMI), and cost data. Regression analysis was performed to evaluate the relationship between cost, CMI, admission volume, and mortality rate.
Results
In total, 338 hospitals provided data for analysis. Mean hospital admission volume was 182 (range, 1-1284), and mean CMI was 1.69 (range, 0.66-6.0). A 1-point increase in hospital average CMI was associated with a 40% increase in odds for high mortality. Admission volume was associated with lower mortality, with 1% lower odds for each additional case. A 1-point increase in CMI produces a $4624 higher total cost per case (95% confidence interval, $4550-$4700), and for each additional case, total cost per case increased by $6.
Conclusion
For otolaryngology inpatient services at US academic medical centers, increasing admission volume is associated with decreased mortality rates, even after controlling for CMI and complication rates. Increasing CMI levels have an anticipated correlation with higher total costs per case, but admission volume is unexpectedly associated with a significant increase in average cost per case.
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