A Population-Based Analysis of Morbidity and Mortality Following Surgery for Intractable Temporal Lobe Epilepsy In The United States

Shearwood McClelland III M.D.^1,4, Hongfei Guo Ph.D.², Kolawole S. Okuyemi M.D., M.P.H.^3,4

¹Department of Neurological Surgery, Boston University School of Medicine, Boston, MA; ²Division of Biostatistics and Clinical and Translational Science Institute, University of Minnesota School of Public Health, Minneapolis, MN; ³Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN; ⁴Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, MN

Introduction:

Intractable temporal lobe epilepsy (TLE) is one of the most common epilepsy syndromes, with Class I evidence demonstrating the superiority of anterior temporal lobectomy (ATL) over continued medical therapy.  Despite this data, reservations persist among some regarding the morbidity of ATL for TLE.  To address this concern, the morbidity of TLE surgery was assessed on a nationwide level.

Methods:

The Nationwide Inpatient Sample from 1988-2003 was used for analysis.  Only patients who were admitted for ATL for TLE (ICD-9-CM=345.41, 345.51; primary procedure code=01.53) were included.  Analysis was adjusted for several variables including patient age, race, sex, admission type, primary payer for care, income in ZIP code of residence, and hospital volume of care.

Results:

Multivariate analyses revealed that the overall morbidity (postoperative morbidity and/or adverse discharge disposition) following ATL for TLE was 10.8% with no mortality.  Private insurance decreased postoperative morbidity (OR=0.52; 95% CI=0.28-0.98; p=0.042) and adverse discharge disposition (OR=0.31; 95% CI=0.12-0.81; p=0.017).  Increased patient age increased postoperative morbidity (OR=1.04; 95% CI=1.01-1.07; p=0.027) and adverse discharge disposition (OR=1.08; 95% CI=1.02-1.13; p=0.0039).  Neither gender, income, race nor hospital volume was predictive of postoperative morbidity.  The degree of medical comorbidity directly correlated with the incidence of postoperative morbidity.

Conclusion:

Morbidity following ATL for TLE is low throughout the United States regardless of gender, race, insurance status or income.  Younger age and private insurance status are independently predictive of reduced postoperative morbidity.  In patients with low medical comorbidity, ATL for TLE is safe with low morbidity and no mortality.

Keywords:

Intractable Temporal Lobe Epilepsy, Anterior Temporal Lobectomy, Morbidity, Healthcare Disparities