Hemispherectomy-associated complications from the Kids’ Inpatient Database

Koubeissi, Mohamad Z.; Syed, Tanvir U.; Syed, Ishtiaq; Jordan, James; Alshekhlee, Amer; Kossoff, Eric H.

doi:10.1016/j.eplepsyres.2009.07.008

« Previous Next »Epilepsy Research
Volume 87, Issue 1 , Pages 47-53, November 2009

Hemispherectomy-associated complications from the Kids’ Inpatient Database

Mohamad Z. Koubeissi
- Department of Neurology, University Hospitals Case Medical Center, Case School of Medicine, 11100 Euclid Avenue, Cleveland, OH, USA
- Neurological Institute, University Hospitals Case Medical Center, Case School of Medicine, 11100 Euclid Avenue, Cleveland, OH, USA
- Corresponding author at: Department of Neurology, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106-5040, USA. Tel.: +1 216 844 1764; fax: +1 216 983 3153.
Tanvir U. Syed
- Department of Neurology, University Hospitals Case Medical Center, Case School of Medicine, 11100 Euclid Avenue, Cleveland, OH, USA
- Neurological Institute, University Hospitals Case Medical Center, Case School of Medicine, 11100 Euclid Avenue, Cleveland, OH, USA
Ishtiaq Syed
- Florida International University, Miami, FL, USA
James Jordan
- Department of Neurology, University Hospitals Case Medical Center, Case School of Medicine, 11100 Euclid Avenue, Cleveland, OH, USA
- Neurological Institute, University Hospitals Case Medical Center, Case School of Medicine, 11100 Euclid Avenue, Cleveland, OH, USA
Amer Alshekhlee
- Department of Neurology, University Hospitals Case Medical Center, Case School of Medicine, 11100 Euclid Avenue, Cleveland, OH, USA
- Neurological Institute, University Hospitals Case Medical Center, Case School of Medicine, 11100 Euclid Avenue, Cleveland, OH, USA
Eric H. Kossoff
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD, USA

Received 7 December 2008; received in revised form 16 July 2009; accepted 24 July 2009.

Summary

Carefully selected pediatric patients undergo hemispherectomy (HS) for treatment of refractory epilepsy. HS is associated with a mortality rate of 0–6.6% across studies, mostly due to acute hemorrhage. The purpose of this study was to evaluate in-hospital mortality and predictors of the need for blood transfusion during HS in a large, nationwide cohort in recent years.

Methods

We identified our cohort from the Kids’ Inpatient Database for the years 1997, 2000, and 2003. We queried the database for HS, and for associated diagnoses, including infections, congenital brain anomalies, and blood transfusion, among others. Predictors of blood transfusion were determined using a stepwise conditional logistic regression analysis.

Results

We identified 153 (74 female) patients with HS. Mean age was 6.4±5.6 years (range 2 months to 19 years). None of the socioeconomic factors examined were significant risk factors for blood transfusion. Admission diagnoses were epilepsy (88.3%), congenital brain anomalies (5.2%), and encephalitis (4.6%), among others. One patient died (0.7%) and 56 patients (36.6%) received blood transfusion. Independent risk factors for blood transfusion included congenital brain anomalies, geographic location of the hospitals (Midwest and Southern regions), medium and large hospital bed-sizes, and discharge months from July through September. Younger age was not a risk factor for blood transfusion.

Conclusion

In-hospital mortality of HS is low, and blood transfusion was performed in over one third of patients. There appear to be several risk factors that can predict the likelihood of transfusion and may warrant close observation before hemispherectomy.

Keywords: Hemispherectomy, Intractable epilepsy, Hemimegalencephaly, Blood transfusion