Rate and complications of adult epilepsy surgery in North America: Analysis of multiple databases.
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.
Department of Neurological Surgery, University of California, San Francisco, CA, USA. Electronic address: john.rolston@ucsf.edu.
John D
JD
Rolston
Department of Neurological Surgery, University of California, San Francisco, CA, USA.
Dario J
DJ
Englot
Department of Neurology, University of California, San Francisco, CA, USA.
Robert C
RC
Knowlton
Department of Neurological Surgery, University of California, San Francisco, CA, USA.
Edward F
EF
Chang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D016208:Databases, Factual; D004827:Epilepsy / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
Complications; Demographics; Epilepsy; Epilepsy surgery; Seizures; Temporal lobectomy