Rate and complications of adult epilepsy surgery in North America: Analysis of multiple databases.

Rolston JD, Englot DJ, Knowlton RC, Chang EF
Epilepsy Res. 2016 124: 55-62

PMID: 27259069 · PMCID: PMC5260847 · DOI:10.1016/j.eplepsyres.2016.05.001

Epilepsy surgery is under-utilized, but recent studies reach conflicting conclusions regarding whether epilepsy surgery rates are currently declining, increasing, or remaining steady. However, data in these prior studies are biased toward high-volume epilepsy centers, or originate from sources that do not disaggregate various procedure types. All major epilepsy surgery procedures were extracted from the Centers for Medicare and Medicaid Services Part B National Summary Data File and the American College of Surgeons National Surgical Quality Improvement Program. Procedure rates, trends, and complications were analyzed, and patient-level predictors of postoperative adverse events were identified. Between 2000-2013, 6200 cases of epilepsy surgery were identified. Temporal lobectomy was the most common procedure (59% of cases), and most did not utilize electrocorticography (63-64%). Neither temporal nor extratemporal lobe epilepsy surgery rates changed significantly during the study period, suggesting no change in utilization. Adverse events, including major and minor complications, occurred in 15.3% of temporal lobectomies and 55.6% of hemispherectomies. Our findings suggest stagnant rates of both temporal and extratemporal lobe epilepsy surgery across U.S. surgical centers over the past decade. This finding contrasts with prior reports suggesting a recent dramatic decline in temporal lobectomy rates at high-volume epilepsy centers. We also observed higher rates of adverse events when both low- and high-volume centers were examined together, as compared to reports from high-volume centers alone. This is consistent with the presence of a volume-outcome relationship in epilepsy surgery.

Copyright © 2016 Elsevier B.V. All rights reserved.

MeSH Terms (18)

Adolescent Adult Aged Aged, 80 and over Canada Databases, Factual Epilepsy Female Humans Intraoperative Complications Male Mexico Middle Aged Neurosurgical Procedures Postoperative Complications Treatment Outcome United States Young Adult

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