In-hospital complications of epilepsy surgery: a six-year nationwide experience

Lobectomy for intractable complex partial epilepsy (iCPE) continues to be underutilized despite numerous reports showing low mortality and complications. Our objective was to evaluate patient demographics and in-hospital complications of intracranial electrode (IE) implantation and lobectomy for evaluation and treatment of iCPE in a nationwide cohort in recent years. We queried the Nationwide Inpatient Sample for patients admitted with iCPE in the years 2000-2005. We excluded patients with brain tumors, vascular malformations, and other diagnoses that might cause alteration of awareness or necessitate brain surgery. Patient demographics and in-hospital complications of patients who underwent surgery (lobectomy, IE implantation, or both) were compared to non-surgical patients. In total, 3,005 patients (mean age 31 +/- 16 years, female 51.3%) were included in the analysis. Teaching hospitals admitted the majority (93%), with a median length of stay of 5 days (quartiles 3, 7). Of all iCPE admissions, 484 (16.1%) underwent surgery; 234 patients were evaluated with IE implantation, 182 (6.06%) had lobectomy, and 68 (2.26%) had both procedures in the same hospitalization. We found an increased risk of intracerebral hemorrhage (ICH) in the IE group (OR 14.1, 95% CI 5.22, 38.3), but not in the lobectomy group (OR 1.98, 95% CI 0.24, 16.2). A similar pattern was seen for status epilepticus (SE) between IE implantation (OR 5.12, 95% CI 1.53, 17.3), and lobectomy (OR 1.95, 95% CI 0.24, 15.8). Procedure utilization insignificantly increased over the 6 years studied (p=0.06). Invasive monitoring is associated with increased risks of ICH and SE. Although the risks of invasive monitoring and lobectomy are low, epilepsy surgery continues to be underutilized in iCPE.