Predictors of Post-Operative Length of Stay and Discharge Location in Vestibular Schwannoma Patients

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