Revisiting racial disparities in access to surgical management of drug-resistant temporal lobe epilepsy post implementation of Affordable Care Act

Sharma, Kanika; Kalakoti, Piyush; Henry, Miriam; Mishra, Vikas; Riel-Romero, Rosario Maria S.; Notarianni, Christina; Nanda, Anil; Sun, Hai

doi:10.1016/j.clineuro.2017.05.001

Cited by 15 publications

(9 citation statements)

References 33 publications

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“…However, the magnitude in the gap between black and non‐Hispanic white patients decreased through the study period, which may in part be due to the implementation of the Affordable Care Act in 2010. A previous study suggested that passing of the Affordable Care Act eliminated racial disparities for access to surgical management of drug‐resistant temporal lobe epilepsy, although our results suggest that racial disparities persisted despite the insurance and economic status of black patients …”

Section: Discussioncontrasting

confidence: 71%

“…A previous study suggested that passing of the Affordable Care Act eliminated racial disparities for access to surgical management of drug-resistant temporal lobe epilepsy, although our results suggest that racial disparities persisted despite the insurance and economic status of black patients. 37 Our analysis of the trends in the use of resective epilepsy surgery for patients with refractory epilepsy also showed that black patients were significantly less likely to receive treatment compared to non-Hispanic white patients. However, the magnitude of the disparity also decreased across the 9 years of the study, although there was no significant change in the overall utilization of resective surgery unlike with VNS implantation.…”

Section: Discussionmentioning

confidence: 75%

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Recent patterns of vagal nerve stimulator use in the United States: Is there a racial disparity?

et al. 2019

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Summary Objective Patients with refractory epilepsy are at a high risk of complications but may not receive the same level of care across racial groups. We aimed to ascertain racial inequalities and trends in the use of a vagal nerve stimulator (VNS) among adult patients with refractory epilepsy. Methods A total of 24 159 adults (18 years and older) with refractory epilepsy from the National Inpatient Sample between the years 2006 and 2014 were included in this analysis. We used a multivariate logistic regression analysis to evaluate independent predictors of VNS use among patients with refractory epilepsy. Covariates included gender, age, insurance type, and household income. In addition, we evaluated for trends in VNS use over the 9‐year period of data collection. Results A total of 1.56% of patients with refractory epilepsy had used a VNS between 2006 and 2014. Overall, there was a trend of decreased use of a VNS between 2006‐2008 (2.1%) and 2012‐2014 (0.9%). In the adjusted multivariate logistic regression analysis, blacks (odds ratio [OR] = 0.52, 95% confidence interval [CI] = 0.35‐0.77) were significantly less likely to have used a VNS relative to non‐Hispanic whites. Additional factors independently associated with a decreased likelihood of VNS use were age > 65 years (OR = 0.51, 95% CI = 0.28‐0.95) and years 2012‐2014 (OR = 0.44, 95% CI = 0.28‐0.67). Significance There was a trend toward a decrease in the use of a VNS among adult patients with refractory epilepsy. Our results also suggest that black patients with refractory epilepsy were less likely to receive a VNS independently of other variables. Increased work toward effectively reducing racial disparities in access to quality epilepsy care is crucial.

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Section: Discussioncontrasting

confidence: 71%

Section: Discussionmentioning

confidence: 75%

Recent patterns of vagal nerve stimulator use in the United States: Is there a racial disparity?

et al. 2019

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“…One positive recent trend in referrals for surgical treatment of epilepsy is that disparities in the U.S., which disadvantage racial minorities (13), may have been reversed as a result of the implementation of the Affordable Care Act (14).…”

Section: Current Trends In the Surgical Treatment For Epilepsymentioning

confidence: 99%

The current place of epilepsy surgery

Engel¹

2018

Current Opinion in Neurology

164

137

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“…The GEE model as compared with the traditional logit model is superior in adjusting for clustering outcomes by hospitals 22,25,40,58 and has been used in previous studies involving administrative databases. 27,49,52 Metric end points (hospitalization cost and LOS) were modeled using an ordinary least squares (OLS) regression. Prior to modeling cost data, initial data exploration demonstrated a considerable degree of non-gaussian distribution.…”

Section: Discussionmentioning

confidence: 99%

Adolescent idiopathic scoliosis: risk factors for complications and the effect of hospital volume on outcomes

Menger

Kalakoti

Pugely

et al. 2017

Neurosurgical Focus

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OBJECTIVEAdolescent idiopathic scoliosis (AIS) is the most common form of scoliosis. Limited literature exists defining risk factors associated with outcomes during initial hospitalization in these patients. In this study, the authors investigated patient demographics, clinical and hospital characteristics impacting short-term outcomes, and costs in adolescent patients undergoing surgical deformity correction for idiopathic scoliosis. Additionally, the authors elucidate the impact of hospital surgical volume on outcomes for these patients.METHODSUsing the National Inpatient Sample database and appropriate International Classification of Diseases, 9th Revision codes, the authors identified adolescent patients (10–19 years of age) undergoing surgical deformity correction for idiopathic scoliosis during 2001–2014. For national estimates, appropriate weights provided by the Agency of Healthcare Research and Quality were used. Multivariable regression techniques were employed to assess the association of risk factors with discharge disposition, postsurgical neurological complications, length of hospital stay, and hospitalization costs.RESULTSOverall, 75,106 adolescent patients underwent surgical deformity correction. The rates of postsurgical complications were estimated at 0.9% for neurological issues, 2.8% for respiratory complications, 0.8% for cardiac complications, 0.4% for infections, 2.7% for gastrointestinal complications, 0.1% for venous thromboembolic events, and 0.1% for acute renal failure. Overall, patients stayed at the hospital for an average of 5.72 days (median 5 days) and on average incurred hospitalization costs estimated at $54,997 (median $47,909). As compared with patients at low-volume centers (≤ 50 operations/year), those undergoing surgical deformity correction at high-volume centers (> 50/year) had a significantly lower likelihood of an unfavorable discharge (discharge to rehabilitation) (OR 1.16, 95% CI 1.03–1.30, p = 0.016) and incurred lower costs (mean $33,462 vs $56,436, p < 0.001) but had a longer duration of stay (mean 6 vs 5.65 days, p = 0.002). In terms of neurological complications, no significant differences in the odds ratios were noted between high- and low-volume centers (OR 1.23, 95% CI 0.97–1.55, p = 0.091).CONCLUSIONSThis study provides insight into the clinical characteristics of AIS patients and their postoperative outcomes following deformity correction as they relate to hospital volume. It provides information regarding independent risk factors for unfavorable discharge and neurological complications following surgery for AIS. The proposed estimates could be used as an adjunct to clinical judgment in presurgical planning, risk stratification, and cost containment.

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Revisiting racial disparities in access to surgical management of drug-resistant temporal lobe epilepsy post implementation of Affordable Care Act

Cited by 15 publications

References 33 publications

Recent patterns of vagal nerve stimulator use in the United States: Is there a racial disparity?

Recent patterns of vagal nerve stimulator use in the United States: Is there a racial disparity?

The current place of epilepsy surgery

Adolescent idiopathic scoliosis: risk factors for complications and the effect of hospital volume on outcomes

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