2026 Poster Presentations
P519: PREDICTORS OF POST-OPERATIVE LENGTH OF STAY AND DISCHARGE LOCATION IN VESTIBULAR SCHWANNOMA PATIENTS.
Lourdes Kaufman, BA; Rithvik Ramesh, BA; Stephanie Younan, BS, MPH; Ruben Hernandez, BS; Steven W Cheung, MD; Philip V Theodosopoulos, MD; Ramin Morshed, MD; Nicole T Jiam, MD; University of California, San Francisco
Introduction: Patients who undergo vestibular schwannoma (VS) resection are at risk for a prolonged length of stay (LOS) and discharge to a destination other than home given the intensive perioperative care requirements and potential for neurologic complications. Extended hospital stays and discharge to facilities contribute substantially to healthcare costs. Identifying factors that predict these outcomes is critical for guiding interventions that reduce inpatient resource utilization and overall VS treatment cost.
Methods: Patients who underwent VS resection at a large urban tertiary care center between 2004 and 2024 were retrospectively identified. LOS and discharge location were determined through review of the electronic medical record. Demographic and clinical variables, including age, sex, race, ethnicity, primary language, insurance, CDC-Social Vulnerability Index, Body Mass Index, Charlson Comorbidity Index, Neurofibromatosis II status, initial vs. recurrence treatment, ≥6-month observation prior to surgery, pre-treatment hydrocephalus, preoperative tumor size, surgical approach, operative time, and extent of resection were compared between patients with >75th percentile LOS and ≤75th percentile LOS and those discharged to home vs non-home (i.e., acute rehabilitation, etc.) locations using appropriate parametric and non-parametric statistical tests. Variables associated with >75th percentile LOS and discharge outside of home on univariate analysis (p≤0.2) were subsequently entered into multivariate logistic regression models; adjusted odds ratios (aOR) and 95% confidence intervals (CI) were reported.
Results: Of 472 patients in our cohort, 92 patients (19.5%) had a LOS over the 75th percentile (>6 days). Prolonged LOS was associated with “Other” race (p=0.005), Hispanic/Latino ethnicity (p<0.001), non-English primary language (p=0.006), Medicaid insurance (p<0.001), larger preoperative tumor volume (p<0.001), pretreatment hydrocephalus (p<0.001), longer operative time (p<0.001) and non-home discharge location (p<0.001). On multivariate logistic regression, Asian race (aOR 4.83 [95% CI 1.54-15.70]), Medicaid insurance (aOR 5.22 [95% CI 1.92-15.10]), Medicare insurance (aOR 8.38 [2.23-35.50]), pretreatment hydrocephalus (aOR 5.49 [95% CI 2.31-13.50]), and longer operative time (aOR 1.00 per-min [1.00-1.01]) independently predicted LOS >75th percentile.
A total of 75 patients (15.9%) had discharge to locations other than home. Non-home discharge was significantly associated with older age (p<0.001), Medicare insurance (p<0.001), a higher Charlson Comorbidity Index (p<0.001), initial treatment (compared to recurrence treatment) (p=0.013), pretreatment hydrocephalus (p<0.001), higher preoperative tumor volume (p<0.001), and longer LOS (p<0.001). On multivariate logistic regression, only preoperative hydrocephalus (aOR 3.95 [95% CI 1.69-9.46]) and longer operative time (aOR 1.00 per-min [1.00-1.01]) remained significantly associated with non-home discharge location.
Conclusions: Prolonged LOS was associated with Asian race, Medicaid/Medicare insurance, pretreatment hydrocephalus, and operative time, while discharge outside of home was associated with preoperative hydrocephalus and operative time. These findings highlight potentially vulnerable patient groups and clinical factors. Future work clarifying the drivers of discharge disposition will help inform whether strategies such as closer monitoring and mobilization protocols for patients with hydrocephalus, tailored discharge planning and rehabilitation services, and resource allocation (e.g., case management or social work involvement) for patients with public insurance may reduce morbidity and healthcare utilization.
