Mortality and Morbidity Rates Are Low After Temporal Lobe Epilepsy Surgery
Temporal lobe epilepsy (TLE) surgery for patients with intractable epilepsy is associated with an overall morbidity of 10.8% and no mortality, according to a study published in the February 14 online Archives of Neurology.
“Despite the success of temporal lobectomy in the treatment of intractable TLE, a large majority of patients with TLE are not referred for epilepsy surgery evaluation.… There may be reticence among some providers to refer patients for surgical interventions,” reported Shearwood McClelland 3rd, MD, from the Department of Neurological Surgery at Boston University School of Medicine, and colleagues, who noted that previous analysis placed the risk of permanent postoperative morbidity at 1% to 10%.
The researchers conducted a retrospective analysis of hospital discharge data from 1988 to 2003. The study included 10,723 adult patients admitted to nonfederal hospitals with intractable TLE; 736 received anterior temporal lobectomy.
Eight percent of these patients experienced postoperative complications. The most common were neurologic complications (2.7%), transfusion of packed red blood cells (2.3%), and hematoma (1.2%). There was no mortality rate, and no patients had deep vein thrombosis or pulmonary embolism.
The researchers also found an adverse discharge disposition rate of 4%, meaning that these patients were discharged to rehabilitation centers before going home.
“The vast majority of patients receiving [anterior temporal lobectomy] had no medical comorbidities, and fewer than 3% had more than one comorbidity,” the authors reported. They found that the risk of postoperative morbidity increased with number of comorbidities.
After analyzing discharge data according to patient and hospital information, the researchers found that younger age and private insurance were associated with decreased risk of postoperative morbidity and better hospital discharge disposition. Surgeon volume, hospital bed size, sex, African-American race, Hispanic race, and income were not predictive of postoperative morbidity.
“This finding, in combination with those of several other studies, confirms that [anterior temporal lobectomy] should be viewed by the general medical and social community as safe and that patients with intractable TLE should be referred for epilepsy surgery evaluation, particularly if they have three or fewer medical comorbidities,” the authors concluded.
McClelland S 3rd, Guo H, Okuyemi S. Population-based analysis of morbidity and mortality following surgery for intractable temporal lobe epilepsy in the United States. Arch Neurol. 2011 Feb 14; [Epub ahead of print].