title: Population-based analysis of morbidity and mortality following surgery for intractable temporal lobe epilepsy in the United States.
abstract: OBJECTIVE
  To assess the morbidity of temporal lobe epilepsy (TLE) surgery on a nationwide level in order to address reservations regarding the morbidity of anterior temporal lobectomy (ATL) for TLE despite class I evidence demonstrating the superiority of ATL over continued medical therapy.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  The Nationwide Inpatient Sample from 1988 to 2003 was used for analysis.
  
  
  METHODS
  Only patients who were admitted for ATL for TLE (International Classification of Diseases, Ninth Revision, Clinical Modification codes 345.41 and 345.51; primary procedure code, 01.53) were included.
  
  
  METHODS
  Morbidity and mortality. Analysis was adjusted for several variables including patient age, race, sex, admission type, primary payer for care, income in zip code of residence, and hospital volume of care.
  
  
  RESULTS
  Multivariate analyses revealed that the overall morbidity (postoperative morbidity and/or adverse discharge disposition) following ATL for TLE was 10.8%, with no mortality. Private insurance decreased postoperative morbidity (odds ratio [OR] = 0.52; 95% confidence interval [CI] = 0.28-0.98; P = .04) and adverse discharge disposition (OR = 0.31; 95% CI = 0.12-0.81; P = .02). Increased patient age increased postoperative morbidity (OR = 1.04; 95% CI = 1.01-1.07; P = .03) and adverse discharge disposition (OR = 1.08; 95% CI = 1.02-1.13; P = .004). Neither sex, income, race, nor hospital volume was predictive of postoperative morbidity. The degree of medical comorbidity directly correlated with the incidence of postoperative morbidity.
  
  
  CONCLUSIONS
  Morbidity following ATL for TLE is low throughout the United States regardless of sex, race, insurance status, or income. Younger age and private insurance status are independently predictive of reduced postoperative morbidity. In patients with low medical comorbidity, ATL for TLE is safe, with low morbidity and no mortality.
authors.affiliation: Department of Neurological Surgery, Boston University School of Medicine, 88 E Newton St, Boston, MA 02118, USA.
authors.forename: Shearwood
authors.initials: S
authors.lastname: McClelland
authors.forename: Hongfei
authors.initials: H
authors.lastname: Guo
authors.forename: Kolawole S
authors.initials: KS
authors.lastname: Okuyemi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D038481:Anterior Temporal Lobectomy / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004833:Epilepsy, Temporal Lobe / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult