Abstract Details

Title National Patterns in Pediatric Epilepsy Surgery: An Examination of the Kids' Inpatient Database, 2016-2022

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 11-008

Objective

This study examines trends in pediatric epilepsy surgery from 2016-2022 in the United States of America to assess if insurance-based access gaps persist or are widening.

Background Approximately one-third of epilepsy patients develop drug-resistant epilepsy (DRE), for which surgery offers potential treatment. Previous studies show Medicaid-insured patients receive epilepsy surgery at lower rates than privately insured patients, but whether these disparities are changing remains unclear.

Design/Methods

We analyzed the Kids' Inpatient Database for 2016, 2019, and 2022, identifying pediatric patients (<20 years) with DRE and epilepsy procedures (neurostimulation, LITT, resective surgeries) using ICD-10 codes. Survey-weighted logistic regression models adjusted for age, sex, race/ethnicity, hospital type, and region, with interaction terms examining temporal changes by insurance status.

Results Among 74,975 pediatric hospitalizations with intractable epilepsy, 3,779 (5.0%) underwent surgery. Surgical rates increased from 4.6% (2016) to 5.5% (2022). Brain resection declined (3.1% to 2.9%), while neurostimulation (1.5% to 2.3%) and LITT (0.3% to 0.5%) increased. Urban teaching hospitals performed 99-100% of procedures. Privately insured patients had consistently higher surgical rates than government-insured patients: 5.9% vs 3.3% (2016), 6.7% vs 3.5% (2019), and 8.1% vs 3.6% (2022). Privately insured patients showed significant annual increases in surgery probability (0.113 percentage points, p=0.003), while government-insured patients showed no change (0.016 percentage points, p=0.573). The disparity was most pronounced for neurostimulation (interaction OR 1.09, 95% CI 1.02-1.16, p=0.011).

Conclusions Pediatric epilepsy surgery utilization increased 19.6% from 2016-2022, driven by less invasive procedures. However, privately insured patients experienced rising surgery rates while government-insured patients' rates remained stable, resulting in widening access gaps despite overall surgical advances.

Authors/Disclosures
James Barnett, MD PRESENTER	Dr. Barnett has nothing to disclose.
Jonathan Gabbay, MD	Dr. Gabbay has nothing to disclose.
Wenzhu Mowrey, PhD	An immediate family member of Dr. Mowrey has stock in Google.
Aristea S. Galanopoulou, MD (Albert Einstein College of Medicine)	Dr. Galanopoulou has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Synergy Medical Solutions. The institution of Dr. Galanopoulou has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Epilepsia Open. Dr. Galanopoulou has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurobiology of Disease. The institution of Dr. Galanopoulou has received research support from NINDS. The institution of Dr. Galanopoulou has received research support from US Department of Defense. The institution of Dr. Galanopoulou has received research support from BIOHAVEN. The institution of Dr. Galanopoulou has received research support from Nova Nordisk Foundation. Dr. Galanopoulou has received publishing royalties from a publication relating to health care. Dr. Galanopoulou has received publishing royalties from a publication relating to health care. Dr. Galanopoulou has received publishing royalties from a publication relating to health care. Dr. Galanopoulou has received publishing royalties from a publication relating to health care.

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