Validating the VS-5 Score for Predicting Outcomes After Vestibular Schwannoma Resection in an Institutional Cohort

• Published in: World neurosurgery 2023-08, Vol.176, p.e77-e82
• Main Authors: Nandoliya, Khizar R., Khazanchi, Rushmin, Winterhalter, Emily J., Youngblood, Mark W., Karras, Constantine L., Sonabend, Adam M., Micco, Alan G., Chandler, James P., Magill, Stephen T.
• Format: Article
• Language: English
• Subjects: Acoustic neuroma; Charlson Comorbidity Index; Denervation; Frailty; Humans; Length of Stay; Neuroma, Acoustic - complications; Neuroma, Acoustic - surgery; Outcomes; Patient Discharge; Postoperative Complications - etiology; Retrospective Studies; Vestibular schwannoma
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2023.04.123

The VS-5 index was recently proposed to predict complications, nonroutine discharge, length of stay (LOS), and cost after vestibular schwannoma (VS) resection. The VS-5 ranges from 0–17.86, and a score ≥2 was proposed as being predictive of postoperative adverse events. We sought to determine whether the VS-5 is predictive of nonroutine discharge and length of stay in an institutional cohort. This is a retrospective study of 100 patients undergoing VS resection. For each patient, a VS-5 score was calculated. Bivariate analyses were conducted to determine differences in postoperative outcomes between high- and low-risk subgroups. Area under the receiver operating characteristic curve sensitivity/specificity analysis using Youden's Index was conducted to evaluate the optimal cutoff. Fifty-one (51%) patients were classified as high risk (VS-5 ≥ 2). Patients with VS-5 ≥ 2 had higher frequency of nonroutine discharge (22% vs. 4%, P = 0.0150) and no significant difference in postoperative LOS. The area under the receiver operating characteristic curve for predicting nonroutine discharge was 0.78 ± 0.15 (P < 0.0001). The optimal cutoff for nonroutine discharge was ≥6, higher than the published cutoff of ≥ 2. The new cutoff was predictive of nonroutine discharge (47% vs. 6%, P = 0 < 0.0001) and LOS (6 [3–11] days vs. 3 [1–28] days, P = 0.0001). The VS-5 frailty index predicted nonroutine discharge but not LOS. Youden's index indicates that a cutoff of 6, not 2, is optimal for predicting nonroutine discharge and LOS.