Pediatric Vestibular Schwannoma Hospitalizations in the United States: A National Analysis of Inpatient Resource Utilization

Background/Objectives: To characterize the demographics, inpatient resource utilization, and coded outcomes of pediatric vestibular schwannoma hospitalizations using a national database. Because the Kids’ Inpatient Database records discharges rather than individuals, all measures are reported at the level of the hospital encounter rather than the unique patient. Methods: This was a retrospective cross-sectional study. We analyzed data from the Kids’ Inpatient Database (2003–2019) for patients aged 0–20 years hospitalized with a diagnosis of vestibular schwannoma. Demographics, hospital characteristics, coded adverse diagnoses, surgical intervention, length of stay (LOS), and total charges were assessed. Bivariate and multivariable analyses examined factors associated with surgical resection of vestibular schwannoma. Results: We identified 347 hospitalizations; median age was 16 years and 54.5% were female. Most admissions were for patients who were White (58.5%) and privately insured (68.6%). Surgery occurred in 12.4% of admissions. Surgical stays had longer median LOS (5 vs. 4 days, p = 0.0035) and higher median charges ($82,208.50 vs. $50,723, p = 0.0002). Rates of coded adverse diagnoses during hospitalization were low: facial nerve injury, 12.7%; sensorineural hearing loss, 3.5%; cerebrospinal fluid leak, 0.6%; postoperative infection, 0.9%; and in-hospital mortality, 0.29%. An NF2 diagnosis code was present in 21.9% of hospitalizations, reflecting coded diagnoses rather than true NF2 prevalence, and was more frequent among patients younger than 18 years than among those aged 18–20 years (27.1% vs. 11.9%, p < 0.001). In bivariate comparisons, hydrocephalus (18.6% vs. 8.2%, p = 0.0466) and vagus nerve injury or vocal fold paralysis (9.3% vs. 2.6%, p = 0.0483) were more common among surgical patients. In Firth’s penalized logistic regression, no clinical, demographic, or hospital factor reached significance as an independent predictor of surgery, although the analysis was likely underpowered to detect such associations; trends were observed for vagus nerve injury (OR 4.39, p = 0.065), seizures (OR 2.75, p = 0.077), and vertigo (OR 0.15, p = 0.075). Conclusions: Pediatric vestibular schwannoma hospitalizations are rare, and most admissions did not involve surgical resection during the index hospitalization. When performed, surgery was associated with greater resource use but low rates of coded adverse diagnoses and in-hospital mortality. No factor reached significance as an independent predictor of surgery in the adjusted models, which were likely underpowered given the small number of surgical encounters. Future work linking clinical detail to longitudinal outcomes is needed to refine surgical selection and evaluate potential disparities in care.