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Updated: May 21, 2026
A Unified Methodological Framework for Vestibular Schwannoma Research
Published on: June 20, 2017
Vestibular schwannoma surgical volume and short-term outcomes in Maryland
Bryan K Ward1, Christine G Gourin, Howard W Francis
1Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Objective:
To characterize contemporary practice patterns and outcomes of vestibular schwannoma surgery.
Design:
Cross-sectional analysis.
Setting:
Maryland Health Service Cost Review Commission database.
Patients:
The study included patients who underwent surgery for vestibular schwannoma between 1990 and 2009.
Main Outcome Measures:
Temporal trends and relationships between volume and in-hospital deaths, central nervous system (CNS) complications, length of hospitalization, and costs.
Results:
A total of 1177 surgical procedures were performed by 57 surgeons at 12 hospitals. Most cases were performed by high-volume surgeons (47%) at high-volume hospitals (79%). The number of cases increased from 474 in 1999-2000 to 703 in 2000-2009. Vestibular schwannoma surgery in 2000-2009 was associated with a decrease in CNS complications (odds ratio [OR] 0.4; P < .001) and an increase in cases performed by intermediate-volume (OR, 4.2; P = .002) and high-volume (OR, 3.2; P = .005) hospitals and intermediate-volume (OR, 1.9; P = .004) and high-volume (OR, 1.8; P = .006) surgeons. High-volume care was inversely related to the odds of urgent and emergent surgery (OR, 0.2; P < .001) and readmissions (OR, 0.1; P = .02). Surgeon volume accounted for 59% of the effect of hospital volume for urgent and emergent admissions and 20% for readmissions. After all other variables were controlled for, there was no significant association between hospital or surgeon volume and in-hospital mortality or CNS complications; however, surgery at high-volume hospitals was associated with significantly lower hospital-related costs (P < .001).
Conclusions:
These data suggest increased centralization of vestibular schwannoma surgery, with an increase in cases performed by intermediate- and high-volume providers and meaningful differences in high-volume surgical care that are mediated by surgeon volume and are associated with reduced hospital-related costs. Further investigation is warranted.
