In-hospital Complications/Events among Patients Undergoing Surgery for Sinonasal Malignancies with Skull Base Involvement in the United States

Introduction: The resection of sinonasal malignancies with skull base involvement carries risks of significant morbidity, but there is a paucity of national data on associated in-hospital complications/events. The current study utilizes the Nationwide Inpatient Sample (NIS) to offer contemporary characterization of the complications/events that occur in the United States in these patients.

Methods: The 2010–2014 NIS was queried for patients with a primary diagnosis of sinonasal malignancy (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 160.0–160.9) who underwent primary surgical procedure in the sinonasal cavity (ICD-9-CM 22.0–22.9) with an associated skull base procedure, either open or endoscopic (ICD-9-CM 01.18, 01.24, 01.31, 01.39, 01.51, 01.53, 02.02, 02.04, 02.06, 02.12, 04.42, 22.63). In-hospital complications/events were assessed. Patients who underwent cerebrospinal fluid (CSF) leak repair (ICD-9-CM 02.11, 02.12, 02.99) were then compared with those who did not, according to demographic, socioeconomic, and hospital characteristics. Length of stay and hospital charges were also considered.

Results: Of the 2,149 patients who underwent resection of a sinonasal malignancy during the study period, 1,037 patients (48.3%) underwent a concurrent skull base procedure. Inpatient mortality was 0.5% based on weighted frequencies (N = 5). Acute stroke was quite common at 9.9% (N = 103). Either during their primary surgery or as a separate procedure, 20.3% of patients underwent a CSF leak repair (weighted frequency N = 211). Epistaxis (N = 84; 8.1%) and CSF rhinorrhea (N = 30; 2.9%) were also commonly listed. There was no documentation of meningitis (N = 0, 0%). In comparing patients who underwent CSF leak repair to those who did not, patients who underwent CSF leak repair were more likely to be male (72 vs. 47%; p = 0.029), were more likely to have a longer length of stay (12.2 vs. 4.5 days; p = 0.042), were less likely to have previously undergone radiation (2.4 vs. 5.3%; p = 0.003), and had higher total hospital charges ($164K vs. $83K; p < 0.0001).

Conclusion: Patients who undergo surgical procedures addressing sinonasal malignancies with skull base involvement are at risk for significant in-hospital complications/events such as stroke and mortality. Patients who require CSF leak repair tend to have protracted inpatient courses and incur greater hospital charges. This is the first national study to our knowledge of in-hospital complications/events during admissions for skull base surgery for sinonasal malignancies.