TY - JOUR
T1 - Clinical Staging to Estimate the Probability of Severe Postoperative Complications in Patients with Vestibular Schwannoma
AU - Smith, Harrison J.
AU - Durakovic, Nedim
AU - Patel, Bhuvic
AU - Varagur, Kaamya
AU - Gupta, Shruti
AU - Khan, Amish M.
AU - Kallogjeri, Dorina
AU - Kim, Albert H.
AU - Piccirillo, Jay F.
AU - Buchman, Craig A.
N1 - Funding Information:
Funding/Support: This study was supported by the NIH National Institute on Deafness and Other Communication Disorders under award number T32 DC00002 as well as the National Center for Advancing Translational Sciences of the NIH under award number TL1TR002344.
Funding Information:
reported owning PotentiaMetrics stocks. Dr Kim reported receiving grants from Monteris Medical and personal fees as a Monteris Medical consultant, grants from Stryker, and grants from Collagen Matrix outside the submitted work. Dr Buchman reported receiving grants from the National Institutes of Health (NIH) T32 training grant for Mr Smith during the conduct of the study; personal fees for serving on the surgeon advisory boards of Advanced Bionics, Cochlear Corp, Envoy Medical, and iotaMotion unrelated to the current work; and grants from the US Department of Defense outside the submitted work; in addition, Dr Buchman had a patent for US9,072,468B2 with royalties paid by Advanced Bionics unrelated to the current work. No other disclosures were reported.
Publisher Copyright:
© 2021 American Medical Association. All rights reserved.
PY - 2021/11
Y1 - 2021/11
N2 - Importance: Vestibular schwannomas have long been treated as a homogeneous entity. Clinical symptoms at presentation may help elucidate the underlaying pathophysiologic characteristics of tumor subtypes. Describing the heterogeneity of these benign tumors may assist in predicting clinical outcomes associated with their treatment. Objective: To create a tumor staging system that incorporates symptoms at presentation and tumor size to predict severe surgical complications. Design, Setting, and Participants: A retrospective cohort of patients at a single-center tertiary referral center from January 1, 1998, to October 13, 2020, was studied. Patients diagnosed with sporadic vestibular schwannoma surgically treated at Washington University in St Louis, Missouri, were included. Main Outcomes and Measures: Severe surgical complications within 30 days of surgery as determined by the Clavien-Dindo classification system. Patients experiencing a complication of grade 3 or above were determined to have a severe complication. Results: Of 185 patients evaluated, 40 (22%) had severe postoperative complications. Twenty of the 40 patients (50%) were women; mean (SD) age was 46 (13) years. Patients with severe complications were more likely to have large tumors (>2.5 cm in largest diameter), vestibular symptoms, and recent hearing loss at presentation. Using conjunctive consolidation, a 4-stage clinical severity staging system that incorporates clinical symptoms and tumor size at presentation was created to predict severe complications. The clinical severity staging system demonstrated an improvement in the ability to discriminate severe complications (C index, 0.754; 95% CI, 0.67-0.84) from a model of tumor size alone (C index, 0.706; 95% CI 0.62-0.79). Conclusions and Relevance: This cohort study found that, among patients with vestibular schwannoma, symptoms present at initial evaluation, in addition to tumor size, served as predictors of severe postoperative complications. A new clinical severity staging system incorporating symptoms at presentation can be helpful for clinicians to identify patients at high risk for severe postoperative complications.
AB - Importance: Vestibular schwannomas have long been treated as a homogeneous entity. Clinical symptoms at presentation may help elucidate the underlaying pathophysiologic characteristics of tumor subtypes. Describing the heterogeneity of these benign tumors may assist in predicting clinical outcomes associated with their treatment. Objective: To create a tumor staging system that incorporates symptoms at presentation and tumor size to predict severe surgical complications. Design, Setting, and Participants: A retrospective cohort of patients at a single-center tertiary referral center from January 1, 1998, to October 13, 2020, was studied. Patients diagnosed with sporadic vestibular schwannoma surgically treated at Washington University in St Louis, Missouri, were included. Main Outcomes and Measures: Severe surgical complications within 30 days of surgery as determined by the Clavien-Dindo classification system. Patients experiencing a complication of grade 3 or above were determined to have a severe complication. Results: Of 185 patients evaluated, 40 (22%) had severe postoperative complications. Twenty of the 40 patients (50%) were women; mean (SD) age was 46 (13) years. Patients with severe complications were more likely to have large tumors (>2.5 cm in largest diameter), vestibular symptoms, and recent hearing loss at presentation. Using conjunctive consolidation, a 4-stage clinical severity staging system that incorporates clinical symptoms and tumor size at presentation was created to predict severe complications. The clinical severity staging system demonstrated an improvement in the ability to discriminate severe complications (C index, 0.754; 95% CI, 0.67-0.84) from a model of tumor size alone (C index, 0.706; 95% CI 0.62-0.79). Conclusions and Relevance: This cohort study found that, among patients with vestibular schwannoma, symptoms present at initial evaluation, in addition to tumor size, served as predictors of severe postoperative complications. A new clinical severity staging system incorporating symptoms at presentation can be helpful for clinicians to identify patients at high risk for severe postoperative complications.
UR - http://www.scopus.com/inward/record.url?scp=85116861526&partnerID=8YFLogxK
U2 - 10.1001/jamaoto.2021.2626
DO - 10.1001/jamaoto.2021.2626
M3 - Article
C2 - 34617972
AN - SCOPUS:85116861526
VL - 147
SP - 991
EP - 998
JO - JAMA Otolaryngology - Head and Neck Surgery
JF - JAMA Otolaryngology - Head and Neck Surgery
SN - 2168-6181
IS - 11
ER -