Hemispherectomy-associated complications from the Kids' Inpatient Database

Carefully selected pediatric patients undergo hemispherectomy (HS) for treatment of refractory epilepsy. HS is associated with a mortality rate of 0-6.6% across studies, mostly due to acute hemorrhage. The purpose of this study was to evaluate in-hospital mortality and predictors of the need for blood transfusion during HS in a large, nationwide cohort in recent years.

We identified our cohort from the Kids' Inpatient Database for the years 1997, 2000, and 2003. We queried the database for HS, and for associated diagnoses, including infections, congenital brain anomalies, and blood transfusion, among others. Predictors of blood transfusion were determined using a stepwise conditional logistic regression analysis.

We identified 153 (74 female) patients with HS. Mean age was 6.4+/-5.6 years (range 2 months to 19 years). None of the socioeconomic factors examined were significant risk factors for blood transfusion. Admission diagnoses were epilepsy (88.3%), congenital brain anomalies (5.2%), and encephalitis (4.6%), among others. One patient died (0.7%) and 56 patients (36.6%) received blood transfusion. Independent risk factors for blood transfusion included congenital brain anomalies, geographic location of the hospitals (Midwest and Southern regions), medium and large hospital bed-sizes, and discharge months from July through September. Younger age was not a risk factor for blood transfusion.

In-hospital mortality of HS is low, and blood transfusion was performed in over one third of patients. There appear to be several risk factors that can predict the likelihood of transfusion and may warrant close observation before hemispherectomy.