title: In-hospital complications of epilepsy surgery: a six-year nationwide experience.
abstract: Lobectomy for intractable complex partial epilepsy (iCPE) continues to be underutilized despite numerous reports showing low mortality and complications. Our objective was to evaluate patient demographics and in-hospital complications of intracranial electrode (IE) implantation and lobectomy for evaluation and treatment of iCPE in a nationwide cohort in recent years. We queried the Nationwide Inpatient Sample for patients admitted with iCPE in the years 2000-2005. We excluded patients with brain tumors, vascular malformations, and other diagnoses that might cause alteration of awareness or necessitate brain surgery. Patient demographics and in-hospital complications of patients who underwent surgery (lobectomy, IE implantation, or both) were compared to non-surgical patients. In total, 3,005 patients (mean age 31 +/- 16 years, female 51.3%) were included in the analysis. Teaching hospitals admitted the majority (93%), with a median length of stay of 5 days (quartiles 3, 7). Of all iCPE admissions, 484 (16.1%) underwent surgery; 234 patients were evaluated with IE implantation, 182 (6.06%) had lobectomy, and 68 (2.26%) had both procedures in the same hospitalization. We found an increased risk of intracerebral hemorrhage (ICH) in the IE group (OR 14.1, 95% CI 5.22, 38.3), but not in the lobectomy group (OR 1.98, 95% CI 0.24, 16.2). A similar pattern was seen for status epilepticus (SE) between IE implantation (OR 5.12, 95% CI 1.53, 17.3), and lobectomy (OR 1.95, 95% CI 0.24, 15.8). Procedure utilization insignificantly increased over the 6 years studied (p = 0.06). Invasive monitoring is associated with increased risks of ICH and SE. Although the risks of invasive monitoring and lobectomy are low, epilepsy surgery continues to be underutilized in iCPE.
authors.affiliation: The Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106-5040, USA. mohamad.koubeissi@uhhsopitals.org
authors.forename: Mohamad Z
authors.initials: MZ
authors.lastname: Koubeissi
authors.forename: Araya
authors.initials: A
authors.lastname: Puwanant
authors.forename: Lara
authors.initials: L
authors.lastname: Jehi
authors.forename: Amer
authors.initials: A
authors.lastname: Alshekhlee
mesh_terms: D000293:Adolescent; D000328:Adult; D038481:Anterior Temporal Lobectomy / Q000009:adverse effects*; D002543:Cerebral Hemorrhage / Q000209:etiology; D003866:Depressive Disorder / Q000209:etiology; D004567:Electrodes, Implanted; D017029:Epilepsy, Complex Partial / Q000601:surgery*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D014481:United States; D055815:Young Adult