Trends in Utilization of Epilepsy Surgeries Using the National Inpatient Sample (NIS) in the United States from 2010 to 2020 of 2189814 Patients of Epilepsy

Introduction: Epilepsy accounts for a significant proportion of the world's disease burden, affecting around 50 million people worldwide.

Methods: This is a retrospective cross-sectional study using a NIS (2010:2020) for patients aged ≥18 years admitted with epilepsy as primary diagnosis. We estimated utilization of epilepsy surgeries in US.

Results: A total of 2189814 patients were admitted with primary diagnosis of epilepsy over study period. A total of 39347 epilepsy surgeries were performed. Total number of surgeries increased from 3383(1.65%) in 2010 to 3735 (2.12%) in 2020.The non-procedural group consisted of 1159863 white patients (53%), 475723 black patients (22%) and 263207 Hispanic patients (12%), while the procedural group consisted of 25345 white (64%), 3304 black (8%) and 5551 Hispanic patients (14%) (P < 0.0001). Patients with Medicare insurance were half as likely to receive a procedure (15% vs. 35%, p< 0.0001), Medicaid (27% vs. 29%, p< 0.0001), while patients with private insurance were twice likely to receive a procedure (51% vs. 25%, p< 0.0001). Patients at lowest median house income were less likely to receive a procedure (22% vs.33%, p< 0.0001) while highest median house income was more likely to receive a procedure (24% vs. 19%, p< 0.0001). Patients treated at rural, urban non-teaching were less likely to receive a procedure (0.7% vs. 5% and 1% vs. 21%), while patients treated at the urban teaching hospitals were more likely to receive a procedure (97% vs. 73%) (p < 0.0001). Patients treated at Northeast, South hospitals regions were less likely to receive a procedure (17% vs. 22% and 33% vs. 37%), while who treated at Midwest, West hospitals region more likely to receive a procedure (26% vs 21% and 22% vs. 18%) (P < 0.0001).

Conclusion : We provide novel perspectives on current treatment options, healthcare utilization for epilepsy and factors that play an important role to access epilepsy surgeries.