Rate and complications of adult epilepsy surgery in North America: Analysis of multiple databases.
Rate and complications of adult epilepsy surgery in North America: Analysis of multiple databases.
复制标题
北美成人癫痫手术的比率和并发症：多个数据库的分析。
DOI：
10.1016/j.eplepsyres.2016.05.001
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发表时间：
2016-08
影响因子：
2.2
通讯作者：
Chang EF
中科院分区：
文献类型：
--
作者：
Rolston JD;Englot DJ;Knowlton RC;Chang EF
癫痫手术未得到充分利用，但最近的研究得出了关于癫痫手术率目前是否下降，增加或保持稳定的相互矛盾的结论。然而，这些先前研究中的数据偏向于高容量癫痫中心，或来源于不分解各种手术类型的来源。所有主要癫痫手术程序均摘自医疗保险和医疗补助服务中心B部分国家汇总数据文件和美国外科医生学会国家手术质量改进计划。对手术率、趋势和并发症进行了分析，并确定了术后不良事件的患者水平预测因素。2000-2013年间，共确定了6200例癫痫手术病例。颞叶切除术是最常见的手术（59%的病例），大多数病例不使用皮质电图（63-64%）。在研究期间，颞叶或颞外叶癫痫手术率均无显著变化，表明利用率无变化。不良事件，包括严重和轻微并发症，发生在15.3%的颞叶切除术和55.6%的半球切除术。我们的研究结果表明，在过去的十年中，美国外科中心的颞叶和颞叶外癫痫手术率停滞不前。这一发现与先前的报告形成对比，该报告表明最近在高容量癫痫中心的颞叶切除率急剧下降。我们还观察到，与仅来自高容量中心的报告相比，当低容量中心和高容量中心一起检查时，不良事件的发生率更高。这与癫痫手术中存在的体积-结果关系一致。
Epilepsy surgery is under-utilized, but recent studies reach conflicting conclusions regarding whether epilepsy surgery rates are currently declining, increasing, or remaining steady. However, data in these prior studies are biased toward high-volume epilepsy centers, or originate from sources that do not disaggregate various procedure types. All major epilepsy surgery procedures were extracted from the Centers for Medicare and Medicaid Services Part B National Summary Data File and the American College of Surgeons National Surgical Quality Improvement Program. Procedure rates, trends, and complications were analyzed, and patient-level predictors of postoperative adverse events were identified. Between 2000–2013, 6200 cases of epilepsy surgery were identified. Temporal lobectomy was the most common procedure (59% of cases), and most did not utilize electrocorticography (63–64%). Neither temporal nor extratemporal lobe epilepsy surgery rates changed significantly during the study period, suggesting no change in utilization. Adverse events, including major and minor complications, occurred in 15.3% of temporal lobectomies and 55.6% of hemispherectomies. Our findings suggest stagnant rates of both temporal and extratemporal lobe epilepsy surgery across U.S. surgical centers over the past decade. This finding contrasts with prior reports suggesting a recent dramatic decline in temporal lobectomy rates at high-volume epilepsy centers. We also observed higher rates of adverse events when both low- and high-volume centers were examined together, as compared to reports from high-volume centers alone. This is consistent with the presence of a volume-outcome relationship in epilepsy surgery.