Early postsurgical evaluation is recommended for patients with brain tumors

Early postsurgical assessment, preferably within 24 hours, of patients who have had benign tumors removed from the base of the brain is recommended to detect trouble chewing and swallowing food, or speaking normally. Such early assessments may minimize complications associated with the sometimes hazelnut-sized tumors, called vestibular schwannomas. Damage can arise when the tumors themselves press on the nearby cranial nerves or from the surgery itself. These nerves are key to controlling the tongue, lips, mouth, and throat.

This study's findings were based on a review of the hospital records of 17,261 men and women participating in the National Inpatient Survey. Researchers found that dysphagia, meaning swallowing problems, were reported in 443 patients (2.6%) who had had a vestibular schwannoma removed. Some form of vocal paralysis occurred in 117 (0.7%) patients. Developing either problem was associated with a more than doubling in the time patients needed to recuperate in the hospital. Patients with no complications had hospital stays that averaged 5.3 days in length. When dysphagia occurred, the average stay was 11.7 days. When vocal cord paralysis occurred, the average stay was 12.1 days.

Moreover, patients who developed swallowing problems were almost twice as likely to be sicker than patients whose swallowing remained normal. Also, dysphagic patients were nearly 18 times more likely to aspirate food into their lungs than non-dysphagic patients (7.1% vs 0.4%) and six times more likely to need immediate, follow-up care and admission to another rehabilitation or chronic care facility (48.5% vs 7.7%). One in five needed a feeding or gastrotomy tube installed.

Patients who experienced vocal cord paralysis were four times more likely to be discharged to another health care facility instead of going home (32.7% vs 7.7%). One in eight needed a breathing or tracheostomy tube placed in their throat to enable speech.

The increased cost for such postsurgical problems ranged between $35,000 and $50,000 per patient, and extended the time needed in the hospital by an average of 1.7 days.

“Our results show the tremendous toll postsurgical complications with swallowing and vocal cord paralysis can exact on health and recovery, even though such problems are not well-reported,” said laryngologist and study senior coinvestigator Lee Akst, MD, of the  Johns Hopkins University School of Medicine in Baltimore, Maryland. Each year, Akst says, his team treats more than a dozen patients who have voice problems after surgery to remove mostly benign vestibular schwannomas, for which the number of new cases reported annually in the United States is estimated at less than 10,000.

“Physicians and speech therapists really need to closely monitor their patients for early signs and symptoms, such as breathy, whispery voices and trouble keeping food in their mouth while chewing, so that aggressive therapy with exercise, medications, or further surgery can be quickly considered,” said Akst.

This study was published in The Laryngoscope (2012; doi:10.1002/lary.23605).

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