National Trends and In-hospital Complication Rates in More Than 1600 Hemispherectomies From 1988 to 2010

Vadera, Sumeet; Griffith, Sandra D.; Rosenbaum, Benjamin P.; Seicean, Andreea; Kshettry, Varun R.; Kelly, Michael L.; Weil, Robert J.; Bingaman, William; Jehi, Lara

doi:10.1227/neu.0000000000000815

Cited by 23 publications

(20 citation statements)

References 28 publications

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“…This rate is remarkably similar to the 56% rate of complications for hemispherectomies observed in the Nationwide Inpatient Sample (Vadera et al, 2015). …”

Section: Discussionsupporting

confidence: 81%

Rate and complications of adult epilepsy surgery in North America: Analysis of multiple databases

et al. 2016

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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.

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“…This rate is remarkably similar to the 56% rate of complications for hemispherectomies observed in the Nationwide Inpatient Sample (Vadera et al, 2015). …”

Section: Discussionsupporting

confidence: 81%

Rate and complications of adult epilepsy surgery in North America: Analysis of multiple databases

et al. 2016

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“…We defined surgical complication using secondary ICD-9-CM codes including stroke and hematoma (432.1, 997.00, 997.01, 997.02, 997.09, 998.11, 998.12), postoperative intracranial infections (320.0, 320.7, 320.81-320.9, 322.9, 998.51, 998.59), status epilepticus (345.3), hydrocephalus (331.3, 331.4), ventriculoperitoneal shunt placement (02.34), blood transfusion (99.01-99.09), postoperative mechanical ventilation (96.70-96.79), and meningitis (320-322, 326). 11 Common in-hospital complication variables included cardiac (997.1, 410), respiratory (518.4, 518.5, 518.81-518.84), renal/urinary (584 and 997.5), and thromboembolic (415, 415.11-415.19, 451.0-451.9). 12 Discharge disposition was dichotomized into "routine" and "adverse discharge," meaning any discharge other than routine (transfer to skilled nursing, intermediate care facility, short-term acute-care hospital, or home health care).…”

Section: Outcome Variablesmentioning

confidence: 99%

“…These surgeries are often performed on young children and are long, tedious surgeries, which often require blood transfusions. Vadera et al 11 utilized the NIS to identify 304 pediatric patients who underwent hemispherectomy between 1988 and 2010. They found that 56% of patients encountered a complication (42% related to surgery).…”

Section: Cause Of Readmissionsmentioning

confidence: 99%

“…They found that 56% of patients encountered a complication (42% related to surgery). 11 In the pediatric population, undergoing such a long, complicated surgery prone to blood loss likely necessitates a transfusion as part of the procedure, and it is unclear if this is truly a preventable complication. The length and complexity of the surgery likely also increased the risk of postoperative infection, as borne out by our data.…”

Section: Cause Of Readmissionsmentioning

confidence: 99%

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Readmission Following Surgical Resection for Intractable Epilepsy: Nationwide Rates, Causes, Predictors, and Outcomes

et al. 2018

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“…sensus arose around prophylactic antibiotics, the use of high-speed drills for bone opening, of nonresorbable material for bone flap closure, of head fixation, of the use of the surgical microscope, and of free bone flaps • On the other hand, many other issues such as the use of ECoG, drains, valproate withdrawal, and so on, remained controversial and should be studied in adequate randomized clinical trials • Further knowledge on these various technical issues might lead to increased standardization and lower costs in the future; these future studies might lead to definitive practice guidelines Pediatric epilepsy surgery has been performed with increasing frequency over the last 30 years in a growing target population. [1][2][3] This is related to increased public awareness that surgical treatment is possible, improved recognition of candidates for surgery, the wider availability of investigational tools (especially magnetic resonance imaging [MRI] and video-electroencephalography [EEG]), improvement in surgical techniques, and the appreciation that seizure cessation for some children may impact positively on cognitive and behavioral development. 4,5 As happens in many areas of surgery, surgical techniques vary between centers, although pediatric epilepsy surgery itself is not new.…”

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confidence: 99%

Technical aspects of pediatric epilepsy surgery: Report of a multicenter, multinational web‐based survey by the ILAE Task Force on Pediatric Epilepsy Surgery

et al. 2016

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SUMMARYSurgical techniques may vary extensively between centers. We report on a web-based survey aimed at evaluating the current technical approaches in different centers around the world performing epilepsy surgery in children. The intention of the survey was to establish technical standards. A request was made to 88 centers to complete a web-based survey comprising 51 questions. There were 14 questions related to general issues, 13 questions investigating the different technical aspects for children undergoing epilepsy surgery, and 24 questions investigating surgical strategies in pediatric epilepsy surgery. Fifty-two centers covering a wide geographic representation completed the questionnaire. The median number of resective procedures per center per year was 47. Some important technical practices appeared (>80% of the responses) such as the use of prophylactic antibiotics (98%), the use of high-speed drills for bone opening (88%), nonresorbable material for bone flap closure (85%), head fixation (90%), use of the surgical microscope (100%), and of free bone flaps. Other questions, such as the use of drains, electrocorticography (ECoG) and preoperative withdrawal of valproate, led to mixed, inconclusive results. Complications were noted in 3.8% of the patients submitted to cortical resection, 9.9% hemispheric surgery, 5% callosotomy, 1.8% depth electrode implantation, 5.9% subdural grids implantation, 11.9% hypothalamic hamartoma resection, 0.9% vagus nerve stimulation (VNS), and 0.5% deep brain stimulation. There were no major differences across regions or countries in any of the subitems above. The present data offer the first overview of the technical aspects of pediatric epilepsy surgery worldwide. Surprisingly, there seem to be more similarities than differences. That aside many of the evaluated issues should be examined by adequately designed multicenter randomized controlled trials (RCTs). Further knowledge on these technical issues might lead to increased standardization and lower costs in the future, as well as definitive practice guidelines.

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National Trends and In-hospital Complication Rates in More Than 1600 Hemispherectomies From 1988 to 2010

Abstract: This is the largest study to date examining hemispherectomy and associated in-hospital complication rates. This study supports early surgery in patients with medically intractable epilepsy and severe hemispheric disease.

Cited by 23 publications

References 28 publications

Rate and complications of adult epilepsy surgery in North America: Analysis of multiple databases

Rate and complications of adult epilepsy surgery in North America: Analysis of multiple databases

Readmission Following Surgical Resection for Intractable Epilepsy: Nationwide Rates, Causes, Predictors, and Outcomes

Technical aspects of pediatric epilepsy surgery: Report of a multicenter, multinational web‐based survey by the ILAE Task Force on Pediatric Epilepsy Surgery

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