Socioeconomic status and time to epilepsy surgery in Australia: A retrospective tertiary centre cohort study

Delayed surgery in patients with drug-resistant epilepsy is associated with increased morbidity and mortality. While health system and clinician-related contributors to delays are recognised, the impact of patient-level factors remains unclear. This study examined the association between socioeconomic status (SES) and time to epilepsy surgery at an Australian tertiary centre.

We retrospectively analysed patients who underwent resective epilepsy surgery between 2006-2019 at Austin Health, Melbourne. Medical records were audited for age at seizure onset, pathology, surgery date, and residential postcode. SES was assigned using the Australian Bureau of Statistics Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD). Time from seizure onset to surgery was analysed using Cox proportional hazards modelling and reported as hazard ratios (HRs).

Among 161 patients (55% male), 132 (82%) had temporal lobe epilepsy. Mean age at seizure onset was 20.8 years (SD 10.4). Median time to surgery was 13.46 years (IQR 7.30-23.48). SES was not associated with time to surgery (p > 0.05). Pathology was associated with differences in surgical timing. Hippocampal sclerosis was associated with longer delays (HR = 0.67, 95% CI 0.47-0.95, p < 0.05), whereas vascular malformations were associated with shorter times to surgery (HR = 2.41, 95% CI 1.41-4.11, p < 0.05). Children and/or patients with intellectual disability had shorter times to surgery (HR = 4.55, 95% CI 0.16-0.43, p < 0.05).

These findings suggest equitable access to epilepsy surgery across SES groups within Australia's public healthcare system. Substantial delays, however, persisted and were associated with specific clinicodemographic factors, highlighting opportunities to improve timely access to surgical care.