Incidence and Long-Term Health Care Utilization Associated With Pseudomeningocele Repair Following Vestibular Schwannoma Resection: A National Database Analysis

Introduction To compare the healthcare utilization in patients who presented with no pseudomeningocele (PSM) following vestibular schwannoma (VS) surgery (nd-PSM), PSM following VS surgery and required surgical repair (s-PSM) and those who presented with PSM and did not require surgical repair (ns-PSM). Methods MarketScan database was queried using the International Classification of Diseases, ninth and tenth revisions, and current procedural terminology four, from 2000 to 2018. We included patients ≥18 years of age with a PSM diagnosis with at least two years of continuous enrollment. The hospital admissions, outpatient services, medication refills, and associated payments were analyzed. Results Of 1,460 patients, 96.6% (n=1,411) had no PSM following surgery for VS, 2.4% (n=35) were in s-PSM and only 0.95% (n=14) were in ns-PSM cohorts. Patients in the s-PSM cohort incurred higher hospital readmission rate, outpatient payments compared to those in the nd-PSM and ns-PSM cohorts at six months, one-year, and two-years following the following VS resection. At one-year following VS resection, the median combined payments for the s-PSM cohort were $74,683 compared to $42,664 for the ns-PSM and $9,476 for the nd-PSM cohort, p<0.0001. Similarly, at two-years, median combined payments for s-PSM cohort were $83,351 compared to $63,942 for ns-PSM and $18,839 for the nd-PSM cohort, p<0.0001. Conclusion Patients in the s-PSM cohort incurred eight times and 4.4 times the combined payments at one- and two-years, respectively, compared to the nd-PSM cohort. Also, patients in the ns-PSM cohort incurred 4.5 times and 3.4 times the payments compared to the nd-PSM cohort.