Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A.
Epilepsia. 2015 Jan;56(1):139-46. doi: 10.1111/epi.12869. Epub 2014 Dec 20.
Hemispherectomy is an established surgical treatment for carefully selected pediatric patients with intractable epilepsy. Published perioperative data report low mortality rates and seizure reduction rates of 50-89%. This study investigates trends in the demographics, hospital utilization, and in-hospital complication rates of patients undergoing hemispherectomy over the past decade in the United States, using the nationally representative Kids' Inpatient Database (KID).
The KID was queried for all discharges with the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure code for hemispherectomy in the years 2000, 2003, 2006, and 2009. The patient cohorts from these four time points were compared, analyzing differences in demographic data, insurance and payer status, total cost, length of stay, in-hospital mortality, and complications. National estimates and 95% confidence intervals are reported given the weighted sample design of KID.
This study identified an estimated total of 552 hospital admissions for hemispherectomy surgery during the years studied in this cohort. The incidence of this procedure increased from 1.2/100,000 admissions in 2000 to 2.2/100,000 in 2009 (p=0.05). Mean age was 6.7 years (range 0-20). There were no significant changes in demographics (age, gender, or race), hospital descriptors (size or type), insurance type, or zip code income quartile. There was a significant increase in total cost, from $42,807 in 2003 to $57,443 in 2009 (p=0.015) (adjusted to 2009 dollars). There were no trends in postoperative complications. In-hospital mortality occurred in five subjects (0.9%). Ventricular shunt placement during hemispherectomy hospitalizations increased over time from 6.7% to 16.5% (p=0.056). Hospitals that performed two or more hemispherectomies yearly had a significantly decreased incidence of in-hospital mortality (odds ratio [OR] 0.08, p=0.04) and an increased incidence of blood transfusion (OR 3.7, p=0.01) compared to hospitals that performed 0-1 procedures a year.
Hemispherectomy procedures increased slightly in frequency over the past decade, with no change in demographic characteristics of the patients over time. Rates of mortality and perioperative complications remained low. Total costs have increased significantly over time. In-hospital mortality was lower in higher volume hospitals.
大脑半球切除术是一种为精心挑选的难治性癫痫儿童患者提供的成熟手术治疗方法。已公布的围手术期数据报告称，该手术的死亡率和 50-89%的癫痫发作减少率较低。本研究使用全国代表性的儿童住院数据库（KID），调查了过去十年中美国接受大脑半球切除术患者的人口统计学、医院利用情况和住院并发症发生率的趋势。
通过国际疾病分类，第九修订版，临床修正（ICD-9-CM）手术代码，在 2000 年、2003 年、2006 年和 2009 年，在 KID 中查询所有出院记录，用于大脑半球切除术。比较这四个时间点的患者队列，分析人口统计学数据、保险和支付人状态、总成本、住院时间、院内死亡率和并发症的差异。由于 KID 的加权样本设计，报告了国家估计数和 95%置信区间。
这项研究确定了在本研究队列中，过去几年共进行了 552 例大脑半球切除术手术。该手术的发病率从 2000 年的 1.2/100,000 次入院增加到 2009 年的 2.2/100,000 次（p=0.05）。平均年龄为 6.7 岁（范围 0-20）。人口统计学特征（年龄、性别或种族）、医院描述符（大小或类型）、保险类型或邮政编码收入四分位数均无显著变化。总成本从 2003 年的 42,807 美元增加到 2009 年的 57,443 美元（p=0.015）（调整为 2009 年美元），有显著增加。术后并发症无明显趋势。院内死亡率发生在 5 名患者中（0.9%）。脑室分流术在大脑半球切除术住院期间的安置比例随着时间的推移从 6.7%增加到 16.5%（p=0.056）。每年进行 2 次或更多大脑半球切除术的医院，院内死亡率的发生率显著降低（比值比[OR]0.08，p=0.04），输血的发生率增加（OR3.7，p=0.01），而每年进行 0-1 次手术的医院则没有这种情况。
过去十年中，大脑半球切除术的频率略有增加，患者的人口统计学特征随时间没有变化。死亡率和围手术期并发症率仍然较低。总成本随着时间的推移显著增加。在高容量医院，院内死亡率较低。
