Abstract：
OBJECTIVE: A surgical \"treatment gap\" in pediatric epilepsy persists despite the demonstrated safety and effectiveness of surgery. For this reason, the national surgical landscape should be investigated such that an updated assessment may more appropriately guide health care efforts.
METHODS: In our retrospective cross-sectional observational study, the National Inpatient Sample (NIS) database was queried for individuals 0 to <18 years of age who had an International Classification of Diseases (ICD) code for drug-resistant epilepsy (DRE). This cohort was then split into a medical group and a surgical group. The former was defined by ICD codes for -DRE without an accompanying surgical code, and the latter was defined by DRE and one of the following epilepsy surgeries: any open surgery; laser interstitial thermal therapy (LITT); vagus nerve stimulation; or responsive neurostimulation (RNS) from 1998 to 2020. Demographic variables of age, gender, race, insurance type, hospital charge, and hospital characteristics were analyzed between surgical options. Continuous variables were analyzed with weight-adjusted quantile regression analysis, and categorical variables were analyzed by weight-adjusted counts with percentages and compared with weight-adjusted chi-square test results.
RESULTS: These data indicate an increase in epilepsy surgeries over a 22-year period, primarily due to a statistically significant increase in open surgery and a non-significant increase in minimally invasive techniques, such as LITT and RNS. There are significant differences in age, race, gender, insurance type, median household income, Elixhauser index, hospital setting, and size between the medical and surgical groups, as well as the procedure performed.
CONCLUSIONS: An increase in open surgery and minimally invasive surgeries (LITT and RNS) account for the overall rise in pediatric epilepsy surgery over the last 22 years. A positive inflection point in open surgery is seen in 2005. Socioeconomic disparities exist between medical and surgical groups. Patient and hospital sociodemographics show significant differences between the procedure performed. Further efforts are required to close the surgical \"treatment gap.\"
METHODS: In our retrospective cross-sectional observational study, the National Inpatient Sample (NIS) database was queried for individuals 0 to <18 years of age who had an International Classification of Diseases (ICD) code for drug-resistant epilepsy (DRE). This cohort was then split into a medical group and a surgical group. The former was defined by ICD codes for -DRE without an accompanying surgical code, and the latter was defined by DRE and one of the following epilepsy surgeries: any open surgery; laser interstitial thermal therapy (LITT); vagus nerve stimulation; or responsive neurostimulation (RNS) from 1998 to 2020. Demographic variables of age, gender, race, insurance type, hospital charge, and hospital characteristics were analyzed between surgical options. Continuous variables were analyzed with weight-adjusted quantile regression analysis, and categorical variables were analyzed by weight-adjusted counts with percentages and compared with weight-adjusted chi-square test results.
RESULTS: These data indicate an increase in epilepsy surgeries over a 22-year period, primarily due to a statistically significant increase in open surgery and a non-significant increase in minimally invasive techniques, such as LITT and RNS. There are significant differences in age, race, gender, insurance type, median household income, Elixhauser index, hospital setting, and size between the medical and surgical groups, as well as the procedure performed.
CONCLUSIONS: An increase in open surgery and minimally invasive surgeries (LITT and RNS) account for the overall rise in pediatric epilepsy surgery over the last 22 years. A positive inflection point in open surgery is seen in 2005. Socioeconomic disparities exist between medical and surgical groups. Patient and hospital sociodemographics show significant differences between the procedure performed. Further efforts are required to close the surgical \"treatment gap.\"
摘要：
目的：尽管已证明手术的安全性和有效性，但小儿癫痫的手术“治疗差距”仍然存在。出于这个原因,应调查全国外科景观,以便更新的评估可以更适当地指导医疗保健工作.
方法：在我们的回顾性横断面观察研究中，我们在国家住院患者样本(NIS)数据库中查询了0~<18岁患者的耐药癫痫(DRE)国际疾病分类(ICD)编码.然后将该队列分为医疗组和手术组。前者由-DRE的ICD代码定义，没有随附的手术代码，后者由DRE和以下癫痫手术之一定义:任何开放性手术;激光间质热疗法(LITT);迷走神经刺激;或反应性神经刺激(RNS),从1998年至2020年.年龄的人口统计学变量，性别,种族,保险类型,医院收费,和医院特征进行了手术选择之间的分析。连续变量采用权重调整分位数回归分析，和分类变量通过重量调整计数和百分比进行分析，并与重量调整卡方检验结果进行比较。
结果：这些数据表明，在22年的时间里，癫痫手术增加，主要是由于开放手术在统计上显着的增加和微创技术的非显着增加，如LITT和RNS。年龄差异显著,种族,性别,保险类型,家庭收入中位数，Elixhauser指数,医院设置，以及医疗和手术组之间的规模，以及所执行的程序。
结论：开放手术和微创手术（LITT和RNS）的增加是小儿癫痫手术在过去22年中的总体增长。2005年发现开放手术的积极拐点。医疗和手术组之间存在社会经济差异。患者和医院的社会人口统计学显示所执行的程序之间存在显着差异。需要进一步努力缩小手术治疗差距。\"
方法：在我们的回顾性横断面观察研究中，我们在国家住院患者样本(NIS)数据库中查询了0~<18岁患者的耐药癫痫(DRE)国际疾病分类(ICD)编码.然后将该队列分为医疗组和手术组。前者由-DRE的ICD代码定义，没有随附的手术代码，后者由DRE和以下癫痫手术之一定义:任何开放性手术;激光间质热疗法(LITT);迷走神经刺激;或反应性神经刺激(RNS),从1998年至2020年.年龄的人口统计学变量，性别,种族,保险类型,医院收费,和医院特征进行了手术选择之间的分析。连续变量采用权重调整分位数回归分析，和分类变量通过重量调整计数和百分比进行分析，并与重量调整卡方检验结果进行比较。
结果：这些数据表明，在22年的时间里，癫痫手术增加，主要是由于开放手术在统计上显着的增加和微创技术的非显着增加，如LITT和RNS。年龄差异显著,种族,性别,保险类型,家庭收入中位数，Elixhauser指数,医院设置，以及医疗和手术组之间的规模，以及所执行的程序。
结论：开放手术和微创手术（LITT和RNS）的增加是小儿癫痫手术在过去22年中的总体增长。2005年发现开放手术的积极拐点。医疗和手术组之间存在社会经济差异。患者和医院的社会人口统计学显示所执行的程序之间存在显着差异。需要进一步努力缩小手术治疗差距。\"
