Socioeconomic status influences time to surgery and surgical outcome in pediatric epilepsy surgery

Rubinger, Luc; Chan, Carol; Andrade, Danielle M.; Go, Cristina; Smith, Mary Lou; Snead, O. Carter; Rutka, James T.; Widjaja, Elysa

doi:10.1016/j.yebeh.2015.12.007

Cited by 49 publications

(33 citation statements)

References 37 publications

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“…89,100,114 Even in Canada where universal health care exists, increased delays in time to surgery were reported in children of lower SES. 115 The authors also found that children of lower SES had poorer seizure outcome. 115 Those with a lower IQ are generally less likely to have epilepsy surgery, though the proportion of those with an IQ < 70 who underwent epilepsy surgery in London, UK study increased from 3% to 10% pre and post 2000 (1988-2007).…”

Section: Barriers To Surgerymentioning

confidence: 95%

“…115 The authors also found that children of lower SES had poorer seizure outcome. 115 Those with a lower IQ are generally less likely to have epilepsy surgery, though the proportion of those with an IQ < 70 who underwent epilepsy surgery in London, UK study increased from 3% to 10% pre and post 2000 (1988-2007). 116 These barriers and disparities provide a strong foundation to guide future implementation strategies to address the many misconceptions about epilepsy surgery and to close the knowledge to action gap for those with epilepsy who may benefit from this efficacious intervention.…”

Section: Barriers To Surgerymentioning

confidence: 95%

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Surgical treatment for epilepsy: the potential gap between evidence and practice

Jetté

Sander

Keezer

2016

The Lancet Neurology

142

133

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Findings from randomised controlled trials, along with more than 100 case series and observational studies, support the efficacy and safety of resective surgery and, more recently, non-resective surgical interventions for the treatment of drug-resistant epilepsy in appropriately selected individuals. There is an argument that epilepsy surgery remains underused, but the evidence to support this assertion is at times unclear. Results from longitudinal studies show a stagnant or declining rate of epilepsy surgery over time, despite the evidence and guidelines supporting its use. Some suggest that this stagnation is due to a decreasing pool of eligible surgical candidates, whereas others emphasise the numerous barriers to epilepsy surgery. Strategies exist to increase access to surgery and to improve communication about the effectiveness of this potentially life-changing procedure. Further investigation into the nature and causes of the presumed underuse of epilepsy surgery and the elaboration of strategies to address this treatment gap are necessary and pressing.

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Section: Barriers To Surgerymentioning

confidence: 95%

Section: Barriers To Surgerymentioning

confidence: 95%

Surgical treatment for epilepsy: the potential gap between evidence and practice

Jetté

Sander

Keezer

2016

The Lancet Neurology

142

133

View full text Add to dashboard Cite

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“…The effect of SES on surgical outcomes is a topic of increasing interest for the surgical community. Unfortunately, the interrelation between SES and various other SDOH makes it difficult to consider in isolation [ 11 - 14 ]. SES has been shown to impact access to surgical care, which has been demonstrated to contribute to poor outcomes, but the effect beyond access to care remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Studies investigating the effect of SDOH on healthcare have gained traction over the past decade and aided in bringing public and academic awareness of this issue [6][7][8][9]. Currently, there exists extensive literature correlating race [9][10], socioeconomic status (SES) [11][12][13][14], and insurance status [8] with increasing disparities for several disease categories and medical services [1]. Importantly, these documented inequities consistently impact post-surgical morbidity and mortality, skewing patient care and outcomes due to socially and culturally defined factors.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Household Economics on Short-Term Outcomes in a Posterior Fossa Tumor Population

Blue¹,

Dimentberg²,

Detchou³

et al. 2020

Cureus

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Background Disparities exist in medical care and may result in avoidable negative clinical care outcomes for those affected. There remains a paucity in the literature regarding the impact of economic disparities on neurosurgical outcomes. Methods A total of 283 consecutive posterior fossa brain tumor resections, excluding cerebellopontine angle tumors, over a six-year period (June 07, 2013, to April 29, 2019) at a single, multihospital academic medical center were analyzed retrospectively. Outcomes evaluated included 30-day readmission and mortality, emergency department (ED) evaluation, unplanned return to surgery within 30 days, and return to surgery after index admission within 30 days. The population was divided into quartiles based on median household income, and univariate analysis was conducted between the lowest (Q1) and highest (Q4) socioeconomic quartiles, with significance set at a p < 0.05. Stepwise regression was conducted to determine the correlations among study variables and identify confounding factors. Results Whole population univariate analysis demonstrated lower socioeconomic status (SES) to be correlated with increased mortality within 30 post-operative days and increased return to surgery after index admission. No significant difference was found with regard to 30-day readmission, ED evaluation, unplanned reoperation, or return to surgery after index admission. Decreasing, but not significant, mortality was demonstrated between Q1 and Q4 socioeconomic quartiles. Conclusions This study suggests that low SES, when defined by household income, correlates with increased mortality within 30 days and an increased need for return to surgery within 30 days. There may be an opportunity for hospitals and care providers to use SES to proactively identify high-risk patients and test the impact of supports in the post-operative setting.

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Using Large-Scale Population-Based Data

Arım¹,

Kohen²

2023

Neurodevelopmental Pediatrics

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Socioeconomic status influences time to surgery and surgical outcome in pediatric epilepsy surgery

Cited by 49 publications

References 37 publications

Surgical treatment for epilepsy: the potential gap between evidence and practice

Surgical treatment for epilepsy: the potential gap between evidence and practice

The Impact of Household Economics on Short-Term Outcomes in a Posterior Fossa Tumor Population

Using Large-Scale Population-Based Data

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