Trends in outcomes, complications, and hospitalization costs for hemispherectomy in the United States for the years 2000–2009

Abstract

SUMMARYObjective: Hemispherectomy is an established surgical treatment for carefully selected pediatric patients with intractable epilepsy. Published perioperative data report low mortality rates and seizure reduction rates of 50-89%. This study investigates trends in the demographics, hospital utilization, and in-hospital complication rates of patients undergoing hemispherectomy over the past decade in the United States, using the nationally representative Kids' Inpatient Database (KID). Methods: The KID was queried for all discharges with the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure code for hemispherectomy in the years 2000, 2003, 2006, and 2009. The patient cohorts from these four time points were compared, analyzing differences in demographic data, insurance and payer status, total cost, length of stay, in-hospital mortality, and complications. National estimates and 95% confidence intervals are reported given the weighted sample design of KID. Results: This study identified an estimated total of 552 hospital admissions for hemispherectomy surgery during the years studied in this cohort. The incidence of this procedure increased from 1.2/100,000 admissions in 2000 to 2.2/100,000 in 2009 (p = 0.05). Mean age was 6.7 years (range 0-20). There were no significant changes in demographics (age, gender, or race), hospital descriptors (size or type), insurance type, or zip code income quartile. There was a significant increase in total cost, from $42,807 in 2003 to $57,443 in 2009 (p = 0.015) (adjusted to 2009 dollars). There were no trends in postoperative complications. In-hospital mortality occurred in five subjects (0.9%). Ventricular shunt placement during hemispherectomy hospitalizations increased over time from 6.7% to 16.5% (p = 0.056). Hospitals that performed two or more hemispherectomies yearly had a significantly decreased incidence of in-hospital mortality (odds ratio [OR] 0.08, p = 0.04) and an increased incidence of blood transfusion (OR 3.7, p = 0.01) compared to hospitals that performed 0-1 procedures a year. Significance: Hemispherectomy procedures increased slightly in frequency over the past decade, with no change in demographic characteristics of the patients over time. Rates of mortality and perioperative complications remained low. Total costs have increased significantly over time. In-hospital mortality was lower in higher volume hospitals.

Prophylactic use of tranexamic acid combined with thrombelastogram guided coagulation management may reduce blood loss and allogeneic transfusion in pediatric hemispherectomy: case series

“…As previously reported [13], the perioperative mortality rate of hemispherectomy is 0% to 1%. Hemispherectomy has the highest morbidity rate among all seizure surgeries, and blood loss commonly exceeds one blood volume [11].…”

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

“…Overall, while complications appear more frequently in the above data, it is likely a reflection of more stringent surveillance by NSQIP and the inclusion of low-volume centers and consequent volume-outcome effects (Englot et al, 2013; Lin et al, 2014). Randomized-clinical trials and academic case series continue to show that epilepsy surgery is safe and effective at those centers (Engel et al, 2012; Hader et al, 2013; Health Quality Ontario, 2012; West et al, 2015; Wiebe et al, 2001).…”

“…Volume-outcome relationships are commonplace throughout neurosurgery (Davies et al, 2015), and specifically in epilepsy surgery (Englot et al, 2013; Rolston et al, 2015). For example, the rate of adverse events for temporal lobectomies at low-volume centers was more than twice that of high-volume centers (12.9 vs. 6.1%) amongst patients in the Nationwide Inpatient Sample (Englot et al, 2013), and mortality was significantly lower for hemispherectomies in higher-volume hospitals than low-volume hospitals (Lin et al, 2014). While we cannot specifically disaggregate our data by hospital size or volume, it is likely that the inclusion of many low-volume centers might partially account for our observed rate of complications.…”

Transfrontal and Transsphenoidal Approaches to Pediatric Craniopharyngioma: A National Perspective

“…The open craniotomy approach is also reported to be associated with an increased incidence of cranial nerve (and other neurological) deficits compared to other approaches [17] . In addition, gross total resection of craniopharyngioma was associated with fewer mean quality-adjusted life years at the 5-year follow-up, compared to more conservative approaches such as biopsy and radiotherapy or endoscopic surgery [10] . While these results do not reflect the experience of all institutions, these studies collectively suggest that risks, benefits, and alternatives to treatment approach should be weighed carefully.…”

“…Age, sex, race, number of diagnoses, TS versus TF approach, hospital volume, and insurance information were included; some continuous variables (such as age) were grouped into categorical variables for clarity of interpretation of analysis. Multiple multivariate ordinary least squares and logistic regressions with independent variables selected a priori were also conducted using methods previously described [10] ; outcomes of interest included CSF leak, complications other than CSF leak, LOS and discharge destination. Data on the specific length of each hospitalization, quantified in days, are included in the KID.…”