Predictors of Postoperative Epilepsy/Seizures in Patients Readmitted After Meningioma Resection

Background: Epilepsy/seizures in meningioma patients may occur pre- or postoperatively, causing significant morbidity and impaired quality of life. Surgical excision is considered a standard management with variable rates of epilepsy/seizure resolution reported after surgery. Employing a national database, we examined the pre- and postoperative incidences of epilepsy/seizures and risk factors associated with postoperative epilepsy/seizures in patients readmitted within 30 days and/or 90 days following meningioma resection. Methods: The 2010-2014 Nationwide Readmissions Database was analyzed. Consecutive patients undergoing surgery for meningioma resection were identified using appropriate ICD-9-CM codes. Standard descriptive techniques and multivariate regression were used to identify predictors of postoperative epilepsy/seizure after discharge. Results: Among 46,107 patients undergoing meningioma resection at index hospitalization, 20.40% (n = 9408) had preoperative epilepsy/seizure diagnosis. The mean patient age was 58.37 ± 13.85 years. Patients with preoperative epilepsy/seizures were more likely to be male (p < 0.001), frail (p < 0.001), and with higher comorbidity index scores (p < 0.001). The overall readmission rate was 30.36% and was higher among patients with preoperative epilepsy/seizures (36.66% vs. 28.75%, p < 0.001). Respectively, 30- and 90-day readmission rates were higher among patients (13.22% vs. 11.73%, p < 0.001) and (23.25% vs 20.30%, p = 0.04) with epilepsy/seizure diagnosis at index admission. Predictors of postoperative epilepsy/seizures at 30- and 90-day readmissions included the preoperative epilepsy/seizure, malignant meningioma, peritumoral cerebral edema, and higher comorbidity index scores, while male sex was significant only at 30-day readmissions. Intraoperative electrocorticography was associated with a decreased likelihood of postoperative epilepsy/seizures. Conclusion: Development of epilepsy/seizures after meningioma resection is likely multifactorial. Identifying factors associated with postoperative epilepsy/seizures after discharge is important in triaging and closer monitoring of at-risk patients and for adapting management to help improve outcomes.