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Thirty-day outcomes in pediatric epilepsy surgery

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Abstract

Purpose

The aim of this study was to use the multicenter American College of Surgeons National Surgical Quality Improvement Program–Pediatric (NSQIP-P) to evaluate and identify risk factors for 30-day adverse events in children undergoing epilepsy surgery.

Methods

Using the 2015 NSQIP-P database, we identified children (age 0–18 years) undergoing pediatric epilepsy surgery and analyzed NSQIP-defined complications, unplanned reoperations, and unplanned readmissions. Multivariable logistic regression analysis was performed using perioperative data to identify risk factors for adverse events within 30 days of the index procedure.

Results

Two hundred eight pediatric patients undergoing epilepsy surgery were identified for the year 2015 in the NSQIP-P database. The majority of patients were male (51.8%) and white (72.9%). The median age was 10 years. Neurological and neuromuscular comorbidities were seen in 62.5% of patients. Surgical blood loss and transfusion was the most common overall NSQIP-defined event (15.7%) and was reported in 40% with hemispherectomy. Nineteen patients (6.8%) had an unplanned reoperation and 20 patients (7.1%) had an unplanned readmission. Multivariable logistic regression analysis showed that African American patients (OR 3.26, 95% CI 1.29–8.21, p = 0.01) and hemispherectomy (OR 3.05, 95% CI 1.4–6.65, p = 0.01) were independently associated with NSQIP-defined complications. Patients undergoing hemispherectomy (OR 4.11, 95% CI 1.48–11.42, p = 0.01) were also at significantly higher risk of unplanned readmission after pediatric epilepsy surgery.

Conclusions

Data from the 2015 NSQIP-P database showed that hemispherectomy was significantly associated with higher perioperative events in children undergoing epilepsy surgery. Quality improvement initiatives for hemispherectomy should target surgical blood loss and wound-related complications. Racial disparities in access to cranial pediatric epilepsy surgery and perioperative complications were also highlighted in the present study.

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Texas Children’s Hospital, Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA

    Aditya Vedantam, I-Wen Pan, Kristen A. Staggers & Sandi K. Lam

Authors
  1. Aditya Vedantam
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  2. I-Wen Pan
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  3. Kristen A. Staggers
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  4. Sandi K. Lam
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Corresponding author

Correspondence to Sandi K. Lam.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Disclosures

The authors have no financial disclosures. This manuscript submitted does not contain information about medical devices or drugs.

Ethical approval

De-identified patient information is freely available to all institutional members who comply with the ACS-NSQIP Data Use Agreement. Research with this completely de-identified dataset constitutes non-human subjects research and is exempt from IRB review. The Data Use Agreement implements the protections afforded by the Health Insurance Portability and Accountability Act of 1996 and the ACS-NSQIP Hospital Participation Agreement.

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Vedantam, A., Pan, IW., Staggers, K.A. et al. Thirty-day outcomes in pediatric epilepsy surgery. Childs Nerv Syst 34, 487–494 (2018). https://doi.org/10.1007/s00381-017-3639-z

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  • DOI: https://doi.org/10.1007/s00381-017-3639-z

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