Early Mobilization Protocol Reduces Postoperative Length of Stay After Vestibular Schwannoma Resection

Introduction: Postoperative length of stay (LOS) following vestibular schwannoma (VS) surgery is influenced largely by acute unilateral vestibular loss, gait instability, and the time required to ensure safe discharge home. A structured early mobilization protocol may shorten the postoperative course by accelerating functional recovery through enhanced central vestibular compensation. This study assesses the influence of such a pathway on LOS, postoperative functional outcomes, and readiness for discharge.

Methods: Patients undergoing VS resection from 2011–2024 were retrospectively reviewed. Postoperative LOS was compared between patients treated prior to implementation of an early mobilization protocol (2011-2017) and those treated subsequently (2018-2024). The protocol required ambulation four times daily, including at least one session with the physician care team, and maintaining out‑of‑bed status during daytime hours. Correlation testing and t‑tests were performed. Cost savings were estimated using $3,000 per inpatient day.

Results: A total of 216 patients were included. Mean (standard deviation) tumor size was 2.1 (1.3) cm, with no correlation between tumor size and LOS (r²=0.04, p=1.0). Surgical approaches included translabyrinthine (n=136), retrosigmoid (n=65), and middle cranial fossa (n=15). Mean LOS decreased from 4.7 (2.0) days before protocol implementation to 3.7 (1.5) days immediately after implementation and 2.7 (1.2) days by 2024. LOS reductions were significant in both retrosigmoid (p=0.0004) and translabyrinthine cohorts (p < 0.0001). The average 2‑day reduction corresponded to an estimated $6,000 savings per case.

Conclusions: Implementation of an early mobilization protocol reduced postoperative LOS by an average of 2 days (42.5%). For centers performing 25 VS resections annually, this may yield an estimated yearly cost savings of $150,000.