Resident Geisinger Health System Danville, Pennsylvania, United States
Introduction: While resection is the mainstay treatment for medically refractory epilepsy, newer minimally invasive approaches have been developed in recent years, each presenting a unique complication profile. We analyze the complication rate, predictors of increased complications, and average length of stay (LOS) in various surgical approaches for epilepsy using a large national database.
Methods: The National Inpatient Sample database was queried from the years 2016 to 2018. Patients were first selected by the diagnosis of medically refractory epilepsy. Surgical procedures that were analyzed included open resection, laser interstitial thermal therapy (LITT), radiotherapy, and neurostimulation. Commonly reported respiratory, cardiac, infectious, implant, vascular complications, and LOS were analyzed.
Results: Resection had the highest complication rate at 10.8% (415/3,834 cases), followed by neurostimulation at 4.8% (40/837 cases), while LITT and radiotherapy had n < 10 complications. Compared to LITT, resection had higher odds raiot of complications (OR 2.2, 95% CI: 1.5-3.0). Female sex (OR 0.8, 95% CI: 0.6-0.9), or having private insurance (OR 0.7, 95% CI: 0.5-0.9) were associated with lower odds of complications while being above the median age was associated with higher odds of complications (OR 1.4, 95% CI: 1.1-1.8). The average LOS was longest for resection at 9.6 days, followed by neurostimulation at 5.6 days, radiotherapy at 5.2 days, and LITT at 1.6 days. Being above the median age (OR 1.8, 95% CI: 1.5-2.1), undergoing resection (OR 2.3, 95% CI: 1.8-2.9), or having hypertension (OR 1.3, 95% CI: 1.0-1.7), diabetes (OR 1.5, 95% CI: 1.2-2.0), or complications of any sort (OR 1.9, 95% CI: 1.2-3.0) were associated with higher odds of increased LOS.
Conclusion : The rate of complications for each surgical approach must be carefully considered and weighed against the patient’s specific medical history. Considering these unique factors in future research will allow for targeted preventive management to avoid complications on a personalized basis.
