Early reduction in unplanned healthcare utilization following vagus nerve stimulation for pediatric epilepsy

Vagus nerve stimulation (VNS) is an established adjunctive therapy for pediatric drug-resistant epilepsy (DRE), but objective evidence of its early impact on overall health is limited. Subjective seizure diaries can be influenced by placebo effects, whereas healthcare utilization may serve as a more objective window into the early post-operative course. This study aims to evaluate healthcare utilization in the immediate and subacute recovery phase (0-3 months) following VNS implantation in a large cohort of children with DRE.

We performed a retrospective, single-center, single-surgeon study of 200 consecutive patients (< 20 years old) with DRE who underwent first-time VNS implantation at a Level IV pediatric epilepsy center. The primary outcome was change in acute healthcare utilization, assessed by comparing rates of all-cause and seizure-related unplanned hospital admissions and emergency room (ER) visits in the 90 days before and after surgery.

Unplanned acute healthcare utilization significantly decreased in the 90-day post-operative window compared to preoperative baseline. All-cause unplanned hospital admissions decreased significantly (p = 0.045). This change was driven by a marked reduction in unplanned seizure-related admissions. Unplanned seizure-related admissions decreased from 34 events to 14 (58.8% reduction), and seizure-related ER visits fell from 60 to 35 (41.7% reduction). The acute surgical safety profile was excellent. Ambulatory concerns expressed by patients and caregivers (electronic, telephone, or in clinic encounters) were rare but most commonly involved pain, hoarseness, cough, and wound care questions.

In a large, consecutive, single-surgeon series, pediatric VNS implantation was associated with an early reduction in unplanned acute healthcare utilization and an exceptional surgical safety profile. Our observations suggest that VNS provides a rapid and clinically significant reduction in unplanned seizure-related hospital admissions and ER visits within the first 3 months of implantation. This suggests an early benefit of VNS for children with DRE.