Geographic Disparities in the Surgical Management of Hemifacial Spasm in Canada

Abstract

BackgroundWe aimed to interrogate the Canadian Institute for Health Information (CIHI) database in order to determine the geographic distribution and outcomes of microvascular decompression (MVD) for the treatment of hemifacial spasm (HFS).MethodsThe CIHI database was searched from 2004 to 2017 for relevant diagnostic and procedure codes. A new database was populated with the following categories: year, institution, province, number of interventions per year, and mean length of stay. Descriptive statistics were generated. Provincial utilization rates of MVD for HFS were calculated.ResultsDuring the period 2004-17, we identified 671 MVDs performed for HFS at 20 centers across Canada. During the study period, 286 MVDs (42.6%) were performed at one center in Manitoba. Another 131 (19.5%) and 72 (10.7%) were performed at one center in British Columbia and Ontario, respectively. The remaining 182 (27.1%) MVDs for HFS were performed at 17 centers across the rest of Canada where the mean number of cases performed per year was 1.1 (SD=0.9, range 0.2-2.9). When out-of-province cases were re-allocated to place of residence, the adjusted provincial utilization of MVD for HFS ranged between 0.5 and 6.1 patients per million per year.ConclusionsMicrovascular decompression for HFS is performed relatively rarely and there is a tremendous geographic variation in utilization across Canada. Although most of these surgeries are performed by a few surgeons, more than half of Canadian centers perform an average of less than 1 case per year. Further examination of the impact of these discrepancies appears warranted.

Hemifacial spasm: a neurosurgical perspective

“…Similarly, in Canada, there were 671 MVDs for HFS performed from 2004 to 2017, an average of 52 cases annually. 38 A total of 73% of these cases were performed at three centers. The other 27% of MVDs for HFS were performed at 17 other centers where the mean number of cases per year was 1.1 (SD 0.9, range 0.2-2.9).…”