Disparities in Epilepsy Surgery for Medically Refractory Epilepsy: Insights from the National Inpatient Sample Database (2016-2019)
Prabandh Buchhanolla1, Monika Thapa2, Abdullahi Musa Adamu1, Lakshmi Chandaluri1, Saurabh Kataria3, Mostafa Hotait1, Roohi Katyal4, Vijayakumar Javalkar5
1LSUHS, 2Department of Neurology, 3lsuhs, 4Louisiana State University Health Sciences Center, 5LSUHSC Shreveport
Objective:
To analyze disparities in the utilization of epilepsy surgery among patients with refractory epilepsy inNational Inpatient Sample database from 2016 to 2019
Background:
Epilepsy imposes a substantial global health burden. Uncontrolled seizures can lead to physical injuries and an increased risk of sudden unexpected death in epilepsy (SUDEP). Despite the growing recognition of epilepsy surgery as an effective treatment, particularly for drug-resistant cases, the trend of patient population undergoing this procedure remains unexpectedly low
Design/Methods:
We extracted data from National Inpatient Sample database from 2016 to 2019, utilizing ICD-10 diagnosis codes and selected patients with admission diagnosis of Intractable Epilepsy and Epileptic surgeries (7.3%) (resective (4%) and implantation/stimulation (3.3%) surgery). Chi-square and T-test were used for descriptive analysis for categorical and continuous variables respectively
Results:
Among 26,881 patients with intractable epilepsy, the epilepsy surgery rates were similar between pediatric (<18) and adult populations (7.1% vs. 7.4%, p =0.56). White patients were more likely to undergo surgery compared to medical management (68.8% vs. 58.6%; p<0.001), while Black patients were more likely to opt for medical management (9.2% vs.17.4%; p<0.001). Patients with private insurance were more likely to undergo epilepsy surgery (49.9% vs. 33.8%; p<0.001) and self-pay group had higher likelihood of pursuing medical management (2.3% vs. 1.4%; p<0.001). Those in third quartile of median household income ($70,999-$93,999) were more likely to undergo surgery (27.7% vs. 23.8%), while those in the lowest median household income (<$55,999) opted more for medical management (29.7% vs. 21.2%)
Conclusions:
Our results highlight disparities in the utilization of epilepsy surgery for refractory epilepsy among different patient demographics, specifically with regards to race and insurance status. These findings provide insights into the factors influencing epilepsy surgery decisions and emphasize the need to address utilization gaps