Patient Characteristics Impacting Adherence to Serial Observation for Vestibular Schwannomas.

ABSTRACT

OBJECTIVE: To examine patient characteristics that impact serial observation adherence among vestibular schwannoma (VS) patients. STUDY DESIGN: Retrospective chart review. SETTING: Single tertiary care center. METHODS: We selected for VS patients from 201 to 2020 who elected for serial observation as initial management. Patients under 18, with previous management, bilateral or intralabyrinthine VS, and neurofibromatosis type 2 were excluded. Demographics, tumor characteristics, and follow-up status were extracted. Single and multiple logistic regression was used to identify patient characteristics impacting follow-up. RESULTS: We identified 507 VS patients who chose serial observation as initial management. Most were female (56.0%), white (73.0%), and married (72.8%). The mean age was 59.3 and most had private insurance (56.4%). Median Charlson Comorbidity Index was 2.00. Mean pure tone audiometry (PTA) average was 41.7 Hz. Average tumor size was 9.04 mm. Of 507 patients, 358 (70.6%) returned for at least one follow-up. On multiple logistic regression analysis, patients with private insurance (odds ratio [OR] 0.39, confidence interval [CI] 0.22-0.68; P = .001), racial minority background (OR 0.54, CI 0.35-0.83; P = .005), worse PTA averages (OR 0.99, CI 0.98-1.00; P = .044), and older age at diagnosis (OR 0.97, CI 0.95-1.00; P = .038) were less likely to follow-up. CONCLUSION: Private health insurance, racial minority background, worse PTA average, and older age were associated with decreased follow-up among adult VS patients electing serial observation. Patients with these characteristics may require additional support to ensure serial observation adherence.