{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T21:53:50Z","timestamp":1790114030144,"version":"4.0.1"},"reference-count":78,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2012,9]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>Hospitalization cost and patient outcome after acoustic neuroma surgery depend on several factors. There is a paucity of data regarding the relationship between demographic features such as age, sex, race, insurance status, and patient outcome. Apart from demographic factors, there are several hospital-related factors and regional issues that can affect outcomes and hospital costs. To the authors' knowledge, no study has investigated the issue of regional disparity across the country in terms of cost of hospitalization and discharge disposition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The authors analyzed the Nationwide Inpatient Sample (NIS) database over the years 2005\u20132009. Several variables were analyzed from the database, including patient demographics, comorbidities, and surgical complications. Hospital variables, such as bedsize, rural\/urban location, teaching status, federal or private ownership, and the region, were also examined. Patient outcome and increased hospitalization costs were the dependent variables studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 2589 admissions from 242 hospitals were analyzed from the NIS data over the years 2005\u20132009. The mean age was 48.99 \u00b1 13.861 years (\u00b1 SD), and 304 (11.7%) of the patients were older than 65 years. The cumulative cost incurred by the hospitals from 2005 to 2009 was $948.77 million. The mean expenditure per admission was $76,365.09 \u00b1 $58,039.93. The mean total charges per admission rose from $59,633.00 in 2005 to $97,370.00 in 2009. The factors that predicted most significantly with other than routine (OTR) disposition outcome were age older than 65 years (OR 2.22, 95% CI 1.411\u20133.518; p &lt; 0.001), aspiration pneumonia (OR 16.085, 95% CI 4.974\u201352.016; p &lt; 0.001), and meningitis (OR 11.299, 95% CI 3.126\u201340.840; p &lt; 0.001). When compared with patients with Medicare and Medicaid, patients with private insurance had a protective effect against OTR disposition outcome. Higher comorbidities predicted independently for OTR disposition outcome (OR 1.409, 95% CI 1.072\u20131.852; p = 0.014). The West region predicted negatively for OTR disposition outcome. Large hospitals were independently associated with higher hospital charges (OR 4.269, 95% CI 3.106\u20135.867; p &lt; 0.001). The West region had significantly higher (p &lt; 0.001) mean hospital charges than the other regions. Patient factors such as meningitis and aspiration pneumonia were strong independent predictors of increased hospital charges (p &lt; 0.001). Higher comorbidities (OR 1.297, 95% CI 1.036\u20131.624; p = 0.023) and presence of neurofibromatosis Type 2 (OR 2.341, 95% CI 1.479\u20133.707; p &lt; 0.001) were associated with higher hospital charges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The authors' study shows that several factors can affect patient outcome and hospital charges for patients who have undergone acoustic neuroma surgery. Factors such as younger age, higher ZIP code income, less comorbidity, private insurance, elective surgery, and the West region predicted for better disposition outcome. However, the West region, higher comorbidities, and weekend admissions were associated with higher hospitalization costs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2012.7.focus12193","type":"journal-article","created":{"date-parts":[[2012,9,1]],"date-time":"2012-09-01T12:14:35Z","timestamp":1346501675000},"page":"E3","source":"Crossref","is-referenced-by-count":40,"title":["The impact of comorbidities, regional trends, and hospital factors on discharge dispositions and hospital costs after acoustic neuroma microsurgery: a United States nationwide inpatient data sample study (2005\u20132009)"],"prefix":"10.3171","volume":"33","author":[{"given":"Ashish","family":"Sonig","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imad Saeed","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishi","family":"Wadhwa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jai Deep","family":"Thakur","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil","family":"Nanda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0330003","series-title":"J Neurosurg","first-page":"1220","article-title":"Comparison of the surgical and follow-up costs associated with microsurgical resection and stereotactic radiosurgery for vestibular schwannoma","volume":"108","author":"Banerjee","year":"2008"},{"key":"b2-0330003","series-title":"Laryngoscope","first-page":"1332","article-title":"Surgical excision of acoustic neuroma: patient outcome and provider caseload","volume":"113","author":"Barker","year":"2003"},{"key":"b3-0330003","series-title":"Neurosurgery","first-page":"646","article-title":"Conservative treatment of patients with acoustic tumors","volume":"28","author":"Bederson","year":"1991"},{"key":"b4-0330003","series-title":"Arch Otolaryngol Head Neck Surg","first-page":"161","article-title":"Treatment of acoustic tumors with radiotherapy","volume":"116","author":"Brackmann","year":"1990"},{"key":"b5-0330003","series-title":"BMJ Open","first-page":"e000809","article-title":"How does comorbidity influence healthcare costs? A population-based cross-sectional study of depression, back pain and osteoarthritis","volume":"2","author":"Carstensen","year":"2012"},{"key":"b6-0330003","series-title":"Surg Neurol","first-page":"485","article-title":"The preservation of hearing and facial nerve function in a consecutive series of unilateral vestibular nerve schwannoma surgical patients (acoustic neuroma)","volume":"39","author":"Cerullo","year":"1993"},{"key":"b7-0330003","series-title":"J Clin Epidemiol","first-page":"1234","article-title":"The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients","volume":"61","author":"Charlson","year":"2008"},{"key":"b8-0330003","series-title":"Am J Med","first-page":"151","article-title":"Effects of weekend admission and hospital teaching status on in-hospital mortality","volume":"117","author":"Cram","year":"2004"},{"key":"b9-0330003","series-title":"Curr Opin Otolaryngol Head Neck Surg","first-page":"305","article-title":"Controversies in building a management algorithm for vestibular schwannomas","volume":"14","author":"Doherty","year":"2006"},{"key":"b10-0330003","series-title":"J Neurosurg","first-page":"901","article-title":"Current results of the retrosigmoid approach to acoustic neurinoma","volume":"76","author":"Ebersold","year":"1992"},{"key":"b11-0330003","series-title":"J Neurosurg","first-page":"910","article-title":"Hearing preservation in acoustic neurinoma surgery","volume":"76","author":"Fischer","year":"1992"},{"key":"b12-0330003","series-title":"Br J Neurosurg","first-page":"169","article-title":"Radiosurgery: a minimally interventional alternative to microsurgery in the management of acoustic neuroma","volume":"10","author":"Forster","year":"1996"},{"key":"b13-0330003","series-title":"J Neurosurg","first-page":"864","article-title":"Preservation of hearing in surgery for acoustic neuromas","volume":"78","author":"Glasscock","year":"1993"},{"key":"b14-0330003","series-title":"Am J Otol","first-page":"236","article-title":"Management of acoustic neuroma in the elderly population","volume":"18","author":"Glasscock","year":"1997"},{"key":"b15-0330003","series-title":"Otolaryngol Head Neck Surg","first-page":"146","article-title":"Facial nerve grading system","volume":"93","author":"House","year":"1985"},{"key":"b16-0330003","series-title":"Surg Neurol","first-page":"283","article-title":"Surgery combined with radiosurgery of large acoustic neuromas","volume":"59","author":"Iwai","year":"2003"},{"key":"b17-0330003","series-title":"Neurosurgery","first-page":"874","article-title":"Implications of cystic features in vestibular schwannomas of patients undergoing microsurgical resection","volume":"68","author":"Jian","year":"2011"},{"key":"b18-0330003","series-title":"Neuro Oncol","first-page":"1252","article-title":"Morbidity and mortality following acoustic neuroma excision in the United States: analysis of racial disparities during a decade in the radiosurgery era","volume":"13","author":"McClelland","year":"2011"},{"key":"b19-0330003","series-title":"J Neurointerv Surg","article-title":"In-hospital outcomes associated with stent-assisted endovascular treatment of unruptured cerebral aneurysms in the USA","author":"McDonald","year":"2012"},{"key":"b20-0330003","series-title":"Orthopedics","first-page":"e598","article-title":"Cost-effectiveness of teaching hospitals for the operative management of hip fractures","volume":"34","author":"McGuire","year":"2011"},{"key":"b21-0330003","series-title":"Br J Neurosurg","first-page":"550","article-title":"Giant vestibular schwannomas: focusing on the differences between the solid and the cystic variants","volume":"22","author":"Mehrotra","year":"2008"},{"key":"b22-0330003","series-title":"J Neurosurg","first-page":"866","article-title":"Cystic vestibular schwannomas: a possible role of matrix metalloproteinase-2 in cyst development and unfavorable surgical outcome","volume":"106","author":"Moon","year":"2007"},{"key":"b23-0330003","series-title":"Acta Neurochir (Wien)","first-page":"647","article-title":"Treatment of vestibular schwannomas. Why, when and how?","volume":"149","author":"Myrseth","year":"2007"},{"key":"b24-0330003","series-title":"Ann Surg Oncol","article-title":"Racial and gender disparities and the role of primary tumor type on inpatient outcomes following craniotomy for brain metastases","author":"Nu\u00f1o","year":"2012"},{"key":"b25-0330003","series-title":"Otol Neurotol","first-page":"473","article-title":"The effect of age on acoustic neuroma surgery outcomes","volume":"24","author":"Oghalai","year":"2003"},{"key":"b26-0330003","series-title":"Otol Neurotol","first-page":"826","article-title":"Cystic vestibular schwannoma: classification, management, and facial nerve outcomes","volume":"30","author":"Piccirillo","year":"2009"},{"key":"b27-0330003","series-title":"Prog Neurol Surg","first-page":"222","article-title":"Vestibular schwannoma management: an evidence-based comparison of stereotactic radiosurgery and microsurgical resection","volume":"21","author":"Pollock","year":"2008"},{"key":"b28-0330003","series-title":"Neurosurgery","first-page":"215","article-title":"Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery","volume":"36","author":"Pollock","year":"1995"},{"key":"b29-0330003","series-title":"Ear Nose Throat J","first-page":"21","article-title":"Acoustic neuroma surgery in patients over 65 years of age","volume":"74","author":"Pulec","year":"1995"},{"key":"b30-0330003","series-title":"Laryngoscope","first-page":"497","article-title":"Natural history of acoustic neuromas","volume":"110","author":"Rosenberg","year":"2000"},{"key":"b31-0330003","series-title":"Neurosurgery","first-page":"640","article-title":"Critical assessment of operative approaches for hearing preservation in small acoustic neuroma surgery: retrosigmoid vs middle fossa approach","volume":"67","author":"Sameshima","year":"2010"},{"key":"b32-0330003","series-title":"J Neurosurg","first-page":"527","article-title":"Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients","volume":"105","author":"Samii","year":"2006"},{"key":"b33-0330003","series-title":"Neurosurgery","first-page":"11","article-title":"Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them","volume":"40","author":"Samii","year":"1997"},{"key":"b34-0330003","series-title":"J Clin Neurosci","first-page":"511","article-title":"Cystic acoustic neuromas: surgical outcome in a series of 58 patients","volume":"15","author":"Sinha","year":"2008"},{"key":"b35-0330003","series-title":"Otolaryngol Head Neck Surg","first-page":"726","article-title":"Acoustic neuroma surgical cost and outcome by hospital volume in California","volume":"130","author":"Slattery","year":"2004"},{"key":"b36-0330003","series-title":"N Engl J Med","first-page":"293","article-title":"Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries","volume":"340","author":"Taylor","year":"1999"},{"key":"b37-0330003","series-title":"Clin Otolaryngol","first-page":"438","article-title":"Evaluation of cost effectiveness for conservative and active management strategies for acoustic neuroma","volume":"34","author":"Verma","year":"2009"},{"key":"b38-0330003","series-title":"Acta Neurochir (Wien)","first-page":"249","article-title":"Direct costs of microsurgical management of radiosurgically amenable intracranial pathology in Germany: an analysis of meningiomas, acoustic neuromas, metastases and arteriovenous malformations of less than 3 cm in diameter","volume":"145","author":"Wellis","year":"2003"},{"key":"b39-0330003","series-title":"Am J Otol","first-page":"177","article-title":"Age considerations in acoustic neuroma surgery: the horns of a dilemma","volume":"10","author":"Wiet","year":"1989"},{"key":"b1-0330003","series-title":"J Neurosurg","first-page":"1220","article-title":"Comparison of the surgical and follow-up costs associated with microsurgical resection and stereotactic radiosurgery for vestibular schwannoma","volume":"108","author":"Banerjee","year":"2008"},{"key":"b2-0330003","series-title":"Laryngoscope","first-page":"1332","article-title":"Surgical excision of acoustic neuroma: patient outcome and provider caseload","volume":"113","author":"Barker","year":"2003"},{"key":"b3-0330003","series-title":"Neurosurgery","first-page":"646","article-title":"Conservative treatment of patients with acoustic tumors","volume":"28","author":"Bederson","year":"1991"},{"key":"b4-0330003","series-title":"Arch Otolaryngol Head Neck Surg","first-page":"161","article-title":"Treatment of acoustic tumors with radiotherapy","volume":"116","author":"Brackmann","year":"1990"},{"key":"b5-0330003","series-title":"BMJ Open","first-page":"e000809","article-title":"How does comorbidity influence healthcare costs? A population-based cross-sectional study of depression, back pain and osteoarthritis","volume":"2","author":"Carstensen","year":"2012"},{"key":"b6-0330003","series-title":"Surg Neurol","first-page":"485","article-title":"The preservation of hearing and facial nerve function in a consecutive series of unilateral vestibular nerve schwannoma surgical patients (acoustic neuroma)","volume":"39","author":"Cerullo","year":"1993"},{"key":"b7-0330003","series-title":"J Clin Epidemiol","first-page":"1234","article-title":"The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients","volume":"61","author":"Charlson","year":"2008"},{"key":"b8-0330003","series-title":"Am J Med","first-page":"151","article-title":"Effects of weekend admission and hospital teaching status on in-hospital mortality","volume":"117","author":"Cram","year":"2004"},{"key":"b9-0330003","series-title":"Curr Opin Otolaryngol Head Neck Surg","first-page":"305","article-title":"Controversies in building a management algorithm for vestibular schwannomas","volume":"14","author":"Doherty","year":"2006"},{"key":"b10-0330003","series-title":"J Neurosurg","first-page":"901","article-title":"Current results of the retrosigmoid approach to acoustic neurinoma","volume":"76","author":"Ebersold","year":"1992"},{"key":"b11-0330003","series-title":"J Neurosurg","first-page":"910","article-title":"Hearing preservation in acoustic neurinoma surgery","volume":"76","author":"Fischer","year":"1992"},{"key":"b12-0330003","series-title":"Br J Neurosurg","first-page":"169","article-title":"Radiosurgery: a minimally interventional alternative to microsurgery in the management of acoustic neuroma","volume":"10","author":"Forster","year":"1996"},{"key":"b13-0330003","series-title":"J Neurosurg","first-page":"864","article-title":"Preservation of hearing in surgery for acoustic neuromas","volume":"78","author":"Glasscock","year":"1993"},{"key":"b14-0330003","series-title":"Am J Otol","first-page":"236","article-title":"Management of acoustic neuroma in the elderly population","volume":"18","author":"Glasscock","year":"1997"},{"key":"b15-0330003","series-title":"Otolaryngol Head Neck Surg","first-page":"146","article-title":"Facial nerve grading system","volume":"93","author":"House","year":"1985"},{"key":"b16-0330003","series-title":"Surg Neurol","first-page":"283","article-title":"Surgery combined with radiosurgery of large acoustic neuromas","volume":"59","author":"Iwai","year":"2003"},{"key":"b17-0330003","series-title":"Neurosurgery","first-page":"874","article-title":"Implications of cystic features in vestibular schwannomas of patients undergoing microsurgical resection","volume":"68","author":"Jian","year":"2011"},{"key":"b18-0330003","series-title":"Neuro Oncol","first-page":"1252","article-title":"Morbidity and mortality following acoustic neuroma excision in the United States: analysis of racial disparities during a decade in the radiosurgery era","volume":"13","author":"McClelland","year":"2011"},{"key":"b19-0330003","series-title":"J Neurointerv Surg","article-title":"In-hospital outcomes associated with stent-assisted endovascular treatment of unruptured cerebral aneurysms in the USA","author":"McDonald","year":"2012"},{"key":"b20-0330003","series-title":"Orthopedics","first-page":"e598","article-title":"Cost-effectiveness of teaching hospitals for the operative management of hip fractures","volume":"34","author":"McGuire","year":"2011"},{"key":"b21-0330003","series-title":"Br J Neurosurg","first-page":"550","article-title":"Giant vestibular schwannomas: focusing on the differences between the solid and the cystic variants","volume":"22","author":"Mehrotra","year":"2008"},{"key":"b22-0330003","series-title":"J Neurosurg","first-page":"866","article-title":"Cystic vestibular schwannomas: a possible role of matrix metalloproteinase-2 in cyst development and unfavorable surgical outcome","volume":"106","author":"Moon","year":"2007"},{"key":"b23-0330003","series-title":"Acta Neurochir (Wien)","first-page":"647","article-title":"Treatment of vestibular schwannomas. Why, when and how?","volume":"149","author":"Myrseth","year":"2007"},{"key":"b24-0330003","series-title":"Ann Surg Oncol","article-title":"Racial and gender disparities and the role of primary tumor type on inpatient outcomes following craniotomy for brain metastases","author":"Nu\u00f1o","year":"2012"},{"key":"b25-0330003","series-title":"Otol Neurotol","first-page":"473","article-title":"The effect of age on acoustic neuroma surgery outcomes","volume":"24","author":"Oghalai","year":"2003"},{"key":"b26-0330003","series-title":"Otol Neurotol","first-page":"826","article-title":"Cystic vestibular schwannoma: classification, management, and facial nerve outcomes","volume":"30","author":"Piccirillo","year":"2009"},{"key":"b27-0330003","series-title":"Prog Neurol Surg","first-page":"222","article-title":"Vestibular schwannoma management: an evidence-based comparison of stereotactic radiosurgery and microsurgical resection","volume":"21","author":"Pollock","year":"2008"},{"key":"b28-0330003","series-title":"Neurosurgery","first-page":"215","article-title":"Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery","volume":"36","author":"Pollock","year":"1995"},{"key":"b29-0330003","series-title":"Ear Nose Throat J","first-page":"21","article-title":"Acoustic neuroma surgery in patients over 65 years of age","volume":"74","author":"Pulec","year":"1995"},{"key":"b30-0330003","series-title":"Laryngoscope","first-page":"497","article-title":"Natural history of acoustic neuromas","volume":"110","author":"Rosenberg","year":"2000"},{"key":"b31-0330003","series-title":"Neurosurgery","first-page":"640","article-title":"Critical assessment of operative approaches for hearing preservation in small acoustic neuroma surgery: retrosigmoid vs middle fossa approach","volume":"67","author":"Sameshima","year":"2010"},{"key":"b32-0330003","series-title":"J Neurosurg","first-page":"527","article-title":"Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients","volume":"105","author":"Samii","year":"2006"},{"key":"b33-0330003","series-title":"Neurosurgery","first-page":"11","article-title":"Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them","volume":"40","author":"Samii","year":"1997"},{"key":"b34-0330003","series-title":"J Clin Neurosci","first-page":"511","article-title":"Cystic acoustic neuromas: surgical outcome in a series of 58 patients","volume":"15","author":"Sinha","year":"2008"},{"key":"b35-0330003","series-title":"Otolaryngol Head Neck Surg","first-page":"726","article-title":"Acoustic neuroma surgical cost and outcome by hospital volume in California","volume":"130","author":"Slattery","year":"2004"},{"key":"b36-0330003","series-title":"N Engl J Med","first-page":"293","article-title":"Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries","volume":"340","author":"Taylor","year":"1999"},{"key":"b37-0330003","series-title":"Clin Otolaryngol","first-page":"438","article-title":"Evaluation of cost effectiveness for conservative and active management strategies for acoustic neuroma","volume":"34","author":"Verma","year":"2009"},{"key":"b38-0330003","series-title":"Acta Neurochir (Wien)","first-page":"249","article-title":"Direct costs of microsurgical management of radiosurgically amenable intracranial pathology in Germany: an analysis of meningiomas, acoustic neuromas, metastases and arteriovenous malformations of less than 3 cm in diameter","volume":"145","author":"Wellis","year":"2003"},{"key":"b39-0330003","series-title":"Am J Otol","first-page":"177","article-title":"Age considerations in acoustic neuroma surgery: the horns of a dilemma","volume":"10","author":"Wiet","year":"1989"}],"container-title":["Neurosurgical 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