Thirty-day non-seizure outcomes following temporal lobectomy for adult epilepsy

Multi-institutional rates of acute adverse outcomes other than seizures after temporal lobectomy (TL) are not well understood. Here we analyzed short-term morbidity and mortality following TL using a validated national database.

The multi-institutional American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried by Current Procedural Terminology (CPT) code for TL procedures performed for adult patients with diagnoses related to epilepsy from 2008 to 2014. Patient demographics, operative variables, hospital variables, preoperative laboratory values, and preexisting comorbidities were analyzed using univariate and multivariate techniques to determine associations with 30-day postoperative morbidity and mortality.

A total of 202 TL procedures were analyzed, 80 (39.6%) with intraoperative electrocorticography (ECOG) and 122 (60.4%) without ECOG. Mean age was 40.4±13.7years, and 47.5% of patients were male. Overall morbidity and mortality were 11.4% and 2.0%, respectively. The most common adverse outcomes were reoperation (5.4%), stroke with residual deficit (2.5%), failure to wean from ventilator (2.0%), and surgical site infection (2.0%). Adverse event rates were not significantly different between TLs with and without ECOG (13.1% vs. 8.8%, p=0.375). Independent predictors of adverse events included prior stroke (OR 7.60, 95% CI 1.22-47.17, p=0.029) and chronic steroid use (OR 10.90, 95% CI 1.03-115.79, p=0.048). Diabetes mellitus (p=0.078) and older age (p=0.145) approached but did not reach significance in the multivariate model.

We report rates of acute morbidity and mortality following TL procedures using a national database. These findings can be used both to assist with patient selection as well as patient counseling prior to surgery.