National Patterns in Pediatric Epilepsy Surgery: An Examination of the Kids' Inpatient Database, 2016-2022
James Barnett MD MS1, Jonathan Gabbay MD2, Wenzhu Mowrey PHD3, Aristea Galanopoulou MD PHD4
1Isabelle Rapin Division of Child Neurology, Montefiore/Albert Einstein College of Medicine, Bronx, New York 10461, USA, 2Department of Pediatrics, Children’s Hospital at Montefiore Einstein/Albert Einstein College of Medicine, Bronx, New York 10461, USA, 3Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York 10461, USA, 4Isabelle Rapin Division of Child Neurology, Montefiore/Albert Einstein College of Medicine, Bronx, New York 10461, USA, Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York 10461, USA
Objective:
This study examines trends in pediatric epilepsy surgery from 2016-2022 in the United States of America to assess if insurance-based access gaps persist or are widening.
Background:
Approximately one-third of epilepsy patients develop drug-resistant epilepsy (DRE), for which surgery offers potential treatment. Previous studies show Medicaid-insured patients receive epilepsy surgery at lower rates than privately insured patients, but whether these disparities are changing remains unclear.
Design/Methods:
We analyzed the Kids' Inpatient Database for 2016, 2019, and 2022, identifying pediatric patients (<20 years) with DRE and epilepsy procedures (neurostimulation, LITT, resective surgeries) using ICD-10 codes. Survey-weighted logistic regression models adjusted for age, sex, race/ethnicity, hospital type, and region, with interaction terms examining temporal changes by insurance status.
Results:
Among 74,975 pediatric hospitalizations with intractable epilepsy, 3,779 (5.0%) underwent surgery. Surgical rates increased from 4.6% (2016) to 5.5% (2022). Brain resection declined (3.1% to 2.9%), while neurostimulation (1.5% to 2.3%) and LITT (0.3% to 0.5%) increased. Urban teaching hospitals performed 99-100% of procedures. Privately insured patients had consistently higher surgical rates than government-insured patients: 5.9% vs 3.3% (2016), 6.7% vs 3.5% (2019), and 8.1% vs 3.6% (2022). Privately insured patients showed significant annual increases in surgery probability (0.113 percentage points, p=0.003), while government-insured patients showed no change (0.016 percentage points, p=0.573). The disparity was most pronounced for neurostimulation (interaction OR 1.09, 95% CI 1.02-1.16, p=0.011).
Conclusions:
Pediatric epilepsy surgery utilization increased 19.6% from 2016-2022, driven by less invasive procedures. However, privately insured patients experienced rising surgery rates while government-insured patients' rates remained stable, resulting in widening access gaps despite overall surgical advances.
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