Transcript Epidural Hematoma: Trends in National Mortality AND Cost

Rehospitalization following
vagal nerve stimulator implant
Paul Kalanithi, MD, Bob Arrigo, BS, Maxwell Boakye, MD, FACS
Outcomes Research Center
Stanford University Department of Neurosurgery
Disclosures: None
VNS FOR EpiLEPSY
• Only 1 prior large database study on vagal nerve
stimulation – only inpatient
• Rehospitalization rates likely to become quality
measure
• This study provides California data regarding 1 year
follow-up data on rehospitalization rates, frequency,
charges and complications of vagal nerve stimulation
for epilepsy
METHODS
 Data Source
 Healthcare Cost and Utiliation Project’s California State Inpatient
Databases (CA-SID), Ambulatory Surgery Database
 collects ICD-9, CPT, and other administrative data on hospitalizations in California
 HCUP verification for longitudinal analysis
 Inclusion/Exclusion criteria
 All patients from 2005-2007 with:
 With primary procedure codes for ICD-9 04.92, 04.93, 86.94, 86.05;
CPT 64573, 61885, 64585, 61888
 Primary diagnosis code for epilepsy ICD-9 345.x
 Variables: age, co-morbidity, gender, race, hospital size, county,
 Outcomes: 1 year rehospitalizations and reoperations, 30 day
complications, mortality, suicide rates
Statistical Analysis
 Predictors of in-hospital complication and adverse
disposition were identified using a univariate and
multivariate logistic regression model.
 P-value < 0.05 or odds ratio excluding 1.00 were
accepted as significant
Data overview
Total
Total number of patients
263
Ambulatory
226
Inpatient
37
Age (median)
37 (18-77)
Comorbidities
0
Insurer
32% Private, 36% Medicare
LOW COMPLICATIONS,
MORTALITY
30 Day Complications:
0.4% - 1 pulmonary event
30 Day Mortality: 0%
REHOSPITALIZATION RATES
• One year rehospitalization rates:
• 118
• 45%
• One Year Suicide Attempt Rate:
• 1.8%
REOPERATION RATES
• One year reoperation rate: 5.7%
• VNS system removals: 5
• IPG replacements: 6
• IPG removals: 4
• Diagnoses:
Infection 2.7%
Device Failure 1.5%
Methodologic
weaknesses
 Only assesses mortality/suicide from clinical settings
 Cannot assess decision for operation/other clinical
factors
 Limitations of ICD-9/CPT codes
 No functional outcomes
SUMMARY
• VNS overall a very safe procedure
• Rehospitalization rates comparable to other procedures
• Reoperation rates 5.7% at 1 year
• HCUP databases can be used for longitudinal data
across multiple care delivery settings