Adverse Events Following Vestibular Schwannoma Surgery: A Comparison of Surgical Approach.

OBJECTIVE: Compare complications of vestibular schwannoma (VS) resection by surgical approach. STUDY DESIGN: Retrospective cohort. SETTING: The 2008 to 2013 American College of Surgeons-National Surgical Quality Improvement Program. PATIENTS: Adult patients with VS resection by an otolaryngologist. INTERVENTIONS: VS resection via transtemporal (TT), retrosigmoid (RS), or middle cranial fossa (MCF) approaches. MAIN OUTCOME MEASURES: Hearing preservation approaches were compared with hearing sacrificing approaches. Demographics and intraoperative factors were analyzed to identify predictors of medical and surgical complications, return to the operating room, and death. The effect of trainee presence was evaluated with respect to complications, operative length, and hospital length of stay. RESULTS: One hundred eleven VS resections were identified. Patients were predominantly women (57%) and older than 50 years (69%). The TT approach accounted for 50% of the cases, while RS (36%) and MCF (14%) were less common. The risk of any postoperative complication was 17%. There were no patient deaths. There was no difference in the overall complication rate among surgical approaches, nor in the overall, surgical, or medical complication rates between hearing preservation and hearing sacrificing approaches. Trainee presence did not change operation length, hospital length of stay, or complication rates. CONCLUSIONS: Complication rates of VS resection are no different when comparing TT, RS, or MCF approaches. Trainee involvement did not significantly affect complications. This study is limited by the inability to evaluate procedure-specific variables (e.g., facial nerve weakness and hearing preservation rates), but offers a unique survey of global 30-day complication rates reported to a large, multi-institutional, publically available database.