LAUSR

BACKGROUND Evolving technologies and healthcare quality metrics have altered treatment algorithms for acoustic neuromas (AN) - increasing trends towards observation and radiosurgery, with proportionate declines in use of microsurgery. Correlation between increasing surgical volumes and superior outcomes has been previously investigated in numerous surgical pathologies, including AN. OBJECTIVE To re-evaluate the volume-outcome relationship of AN resection in a changing healthcare system, with evolving treatment strategies. METHODS Patients who underwent AN resection between 2009-2013 were retrospectively identified in the State Inpatient Database subset of the Healthcare Cost and Utilization Project. Generalized linear mixed-effect models were used to assess odds of various outcome measures (length of stay (LOS), discharge disposition, and facial nerve or severe clinical complications). Institutions were grouped into low volume centers (1-6 cases/year) and high volume centers (HVC; ≥31 cases/year) for analysis. RESULTS 1873 patients underwent AN resection between 2009-2013 with a mean age of 50.1 1 14.1years (1SD) For each additional case performed annually, patients were 2% (OR = 0.98, 95 CI: 0.96-0.99) less likely to experience a severe complication (p = .004). Each additional case also trended towards a decreased rate of facial nerve complications and non-routine discharge. Inpatient LOS was also shorter for patients at HVCs - median 4 versus 5 days (p < .001). CONCLUSION Despite a relative decline in microsurgery compared to previous eras, care at HVC are still associated with superior short-term outcomes, such as decreased LOS, facial nerve or other severe complications, and non-routine discharges.