Is Longer Surgery More Dangerous? Operative Duration Not Associated With Complications After Vestibular Schwannoma Resection.

Objective: To examine the association between operative duration and complications after vestibular schwannoma (VS) surgery.

Study Design: Retrospective chart review.

Setting: Tertiary referral center.

Patients: One hundred forty-eight patients undergoing vestibular schwannoma resection in a single institution.

Intervention: Vestibular schwannoma resection.

Main Outcome Measures: Operative duration, surgical approach, tumor size, and postoperative complications.

Results: Forty-one patients underwent middle cranial fossa (MCF) approach, 46 underwent translabyrinthine (TL) approach, and 61 underwent retrosigmoid (RS) approach. The mean operative duration overall was 407 minutes (MCF-339 min, TL-450 min, RS 420 min). When controlling for tumor size, there was no difference in procedure duration by approach (OR 0.92, CI 0.82-1.02, p=0.11).When controlling for approach, there was a significant increase in procedure duration by tumor size (OR 1.36, CI 1.23-1.50, p < 0.0001). Increased procedure duration was not associated with 30-day readmission (p = 0.82), cerebrospinal fluid leak (CSF) (p = 0.84), return to the operating room (p = 0.75), postoperative deep vein thrombosis (p = 1.0), postoperative stroke (p = 0.23), or postoperative wound complications (p = 0.70). Longer operative time was associated with increased hospital length of stay (p = 0.04). However, when controlling for tumor size and surgical approach, hospital length of stay was no longer associated with increased procedure duration (OR 1.15, CI 0.98-1.33, p = 0.3).

Conclusion: Increased operative duration was associated with larger tumor size; however contrary to previous reports, increased operative duration was not associated with postoperative complications.