Introduction: Anatomic and functional hemispherectomies are relatively infrequent and technically challenging procedures. We utilized the Nationwide Inpatient Sample (NIS) database to report the largest sample of hemispherectomy patients to date, as well as associated patient characteristics and in-hospital complications rates over a 22 year period.
Methods: Between 1988 and 2010, the NIS database identified 304 pediatric patients that underwent hemispherectomy (extrapolating to a total of 1610 patients using the NIS weighting scheme). Descriptive statistics were calculated for patient and hospital characteristics and stratified by the presence of perioperative complications. We fit logistic regression models for each variable with perioperative complications as the binary outcome. A new variable for hospital size was created based on tertiles of discharge numbers amongst included hospitals.
Results: The mean age of the extrapolated sample was 5.9 years, with a non-statistically significant trend towards a lower mean (5.5) in patients without a complication than with a complication (6.1). Forty six percent were female and 54% were white. Complications associated with surgery were noted in 289 patients (including 18% with at least one complication), while in-hospital complications occurred in 394 (24%). 472 patients (29%) required a transfusion. Thirty three (2%) died. There was no association between complication rates and hospital volume when comparing hospitals that perform one or more procedures per year on average to less than one. Large hospital size was associated with a 67% increase in complication rates which approached significance (p=0.064).
Conclusions: Most hemispherectomy studies to date only report single institution outcomes in small cohorts of patients. One benefit of the NIS database is that it provides a much broader understanding of the complication rates and trends in rare procedures across multiple centers and over many years, which is especially helpful when evaluating uncommon procedures such as hemispherectomy.
Patient Care: Current studies on perioperative complications related to hemispherectomy involve very small groups of patients from single institutions. This is the largest cohort of patients undergoing hemispherectomy as well as their associated complications. This is helpful information when guiding patients on whether or not to have this procedure done.
Learning Objectives: By the conclusion of this session, participants should be able to 1) Understand the benefits and drawbacks of using the NIS for looking at national trends in rare procedures 2) Understand the main complications and patient demographics of patients undergoing hemispherectomy 3) Describe the trends in utilization of hemispherectomy over the last 22 years.