Receipt of Resective Surgery for Intractable Pediatric Temporal Lobe Epilepsy In The United States: Examination of Race, Age, Gender and Insurance Status as Predictive Factors
Shearwood McClelland III M.D.1, Colleen C. Curran M.S.2, Cynthia S. Davey M.S.2, Kolawole S. Okuyemi M.D., M.P.H.3
1Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN; 2Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN; 3Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN
Introduction:
For patients with intractable temporal lobe epilepsy (ITLE), resective surgery of the temporal lobe has emerged as the most effective modality, having been proven far superior to continued medical management. Previous reports in adults involving a limited number of centers have indicated that the odds of resective surgery being performed on black ITLE patients is far less than on nonblack patients. The goal of this study was to evaluate whether race and other socio-demographic factors are predictive of receiving resective surgery for pediatric ITLE on a national level.
Methods:
A retrospective cohort study was performed using the Kids' Inpatient Database covering the period of 1997 through 2003. Only children admitted for resective surgery for ITLE (ICD-9-CM = 345.41, 345.51; primary procedure code = 01.53) were included. Variables besides race included were patient age, gender, and primary payer.
Results:
Multivariate analyses revealed no significant difference in the odds of resective surgery being performed on black ITLE children versus nonblack children (OR=0.66, 95% CI=0.28-1.53, p=0.327), or between female and male children (OR=1.11, 95% CI=0.76-1.63, p=0.586). Children of older age were more likely to receive surgery for ITLE (OR=1.07, 95% CI=1.03-1.11, p<0.001 per one year increase in age), as were children with private insurance status (OR=2.21, 95% CI=1.34-3.63, p=0.002).
Conclusion:
In this first nationwide analysis of pediatric ITLE, older age and private insurance status were independently predictive of which children were more likely to receive surgery for ITLE on a national level, while gender was not. Black children with ITLE were no less likely to receive surgical intervention than nonblack children. Similar nationwide analyses involving adults will be required to determine whether these trends for ITLE surgery continue in the adult population.
Keywords:
Intractable Pediatric Temporal Lobe Epilepsy, Resective Surgery, Nationwide Analysis, Black Children, Health Disparities, Insurance Status