Socioeconomic characteristics and outcomes of inpatient cranial nerve decompression procedures: an 18-year HCUP-NIS study

Abstract Background Cranial nerve decompression procedures in the head and neck region are specialized interventions used in selected neuropathic, traumatic, tumor-associated, or compressive conditions. However, their clinical use, patient characteristics, and procedural context remain poorly characterized at the national level. This study evaluated the demographic, socioeconomic, clinical, and procedural features of hospitalized patients undergoing ICD-coded cranial nerve decompression procedures in the United States and assessed variation across nerve types. Methods A retrospective cross-sectional study was performed using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2002 to 2020. Patients undergoing cranial nerve decompression procedures were identified using ICD-9 and ICD-10 procedure codes. Because administrative codes do not provide operative reports or imaging data, the exact anatomical site of compression and surgical approach could not be verified at the individual-patient level. Demographic, clinical, and hospital variables were analyzed, and subgroup comparisons were performed by decompressed nerve. Results A total of 10,463 patients were included (mean age 51.8 years; 60.1% female). Patient characteristics differed significantly across nerve groups. Trigeminal neuralgia and Bell’s palsy were the leading indications. Most patients had private insurance and were routinely discharged home. Hospitalization metrics and comorbidity burden also varied by nerve type, with oculomotor and trochlear nerve procedures showing greater complexity and cost. In-hospital mortality was low (0.3%), and postoperative complications were rare (< 0.2%). In the ICD-10 cohort, trigeminal (70.0%) and facial nerve decompressions (25.7%) were most common. Conclusions ICD-coded cranial nerve decompression procedures are uncommon but vary substantially by nerve type in patient profile and procedural complexity. Low in-hospital complication rates suggest favorable short-term safety, although underreporting and limited follow-up cannot be excluded. These findings highlight geographic and procedure-specific variation, while also underscoring the need for more granular procedural coding and prospective studies with operative-level detail. Level of Evidence: Level III, risk / prognostic study.