Career Center AES Connect

Abstracts

Patient and Pre-surgical Testing Characteristics Contributing to Duration of Evaluation: Identifying Best Practices and Opportunities to Streamline Pediatric Epilepsy Surgery Evaluation

Abstract number : 1.456
Submission category : 9. Surgery / 9B. Pediatrics
Year : 2024
Submission ID : 1270
Source : www.aesnet.org
Presentation date : 12/7/2024 12:00:00 AM
Published date :

Authors :
Presenting Author: M. Scott Perry, MD – Jane and John Justin Institute for Mind Health, Neurosciences Center, Cook Children's Medical Center

Avery Caraway, MS – Cook Children's Medical Center
Emily Brock, BS – Cook Children's Medical Center
Jason Hauptman, MD – Seattle Children's Hospital
Edward Novotny, MD – University of Washington School of Medicine
Debopam Samanta, MD – University of Arkansas for Medical Sciences
Shilpa Reddy, MD, MMHC – Vanderbilt University Medical Center
Abhinaya Ganesh, MD – Vanderbilt University/Monroe Carell Jr Children's Hospital
Kristen Arredondo, MD – University of Texas at Austin
Patricia McGoldrick, NP – Boston Children's Health Physicians
Steven Wolf, MD, FAES – Boston Children's Health Physicians
Kurtis Auguste, MD – University of California-San Francisco
Ernesto Gonzalez-Giraldo, MD – University of California-San Francisco
Adam Ostendorf, MD – Pediatrics, Division of Pediatric Neurology
Michael Ciliberto, MD – University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Rani Singh, MD – Atrium Health/Levine Children's Hospital, Wake Forest University School of Medicine
Jason Coryell, MD – Oregon Health and Sciences University/Doernbecher Children's Hospital
Pilar Pichon, MD – Children's Hospital of Orange County
Daniel Shrey, MD – Children's Hospital of Orange County
Cemal Karakas, MD – University of Louisville School of Medicine/Norton Children's Hospital
Pradeep Javarayee, MD MBA – Medical College of Wisconsin
Lily Wong-Kisiel, MD – Mayo Clinic College of Medicine
Dewi Depositario-Cabacar, MD – Children's National Hospital
Allyson Alexander, MD, PhD – Children's Hospital Colorado
Krista Eschbach, MD – University of Colorado Anschutz Medical Campus – Children’s Hospital Colorado
Erin Fedak Romanowski, MD – University of Michigan
Nancy McNamara, MD – University of Michigan
Priyamvada Tatachar, MD – Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine
William Gaillard, MD – Children's National Hospital
Ahmad Marashly, MD – The Johns Hopkins Hospital
Jeffrey Bolton, MD – Boston Children's Hospital
Jenny Lin, MD – Children's Healthcare of Atlanta
Srishti Nangia, MD – Weill-Cornell Medicine
Samir Karia, MD – University of Louisville School of Medicine/Norton Children's Hospital
Jeetendra Sah, MD – University of Louisville School of Medicine
Ann Hyslop Segeren, MD – Stanford University School of Medicine
Dallas Armstong, MD – UT Southwestern
Stephanie Burkhalter, APRN – Nemours Children's Health
Fernando Galan, MD – Nemours Children's Health

Rationale: Longer duration of epilepsy prior to surgery is a predictor of poor outcome. While referral delays of surgical candidates are well documented, factors causing delay during the pre-surgical evaluation are unclear and may vary depending on institutional characteristics. By benchmarking duration of pre-surgical workup at multiple centers and identifying patient and evaluation characteristics contributing to duration, we can ascertain best practices and address modifiable contributors to reduce delays.

Methods: We queried the Pediatric Epilepsy Research Consortium Surgery Database, a prospective, observational multicenter study enrolling children 0-18 years at 27 US pediatric epilepsy centers, for all patients undergoing initial pre-surgical evaluation for drug resistant epilepsy (DRE). We included patients with completed evaluations and data on duration from initiation of pre-surgical evaluation to final surgical decision. We compared patient characteristics and evaluation components between those with long duration evaluations ( >75% quartile) and those with short (< 25% quartile). Akaike Information Criteria (AIC) selection identified variables associated with longer duration. From these, we developed a logistic prediction model for evaluation duration, using a random 80/20 training/testing split of the entire cohort. The model was tested among institutions with ≥10 patients in the cohort to assess accuracy predicting long durations. Linear models for each site assessed each variable’s impact on duration. Variables with < 10% of the patient population at each site were excluded. Beta values were compared to identify intra- and inter-institution variability and to delineate institutions with shortest added duration for each variable.

Results: Of 2318 patients undergoing surgical evaluation, 1682 (73%) from 23 sites had complete data. Median evaluation duration was 8 weeks (IQR 3-22), 458 (27%) with short duration evaluations and 425 (25%) long duration. Multiple patient and evaluation characteristics were associated with duration (Table 1). 9/13 variables associated with duration met inclusion criteria using AIC methods across all sites when contributing all variables to the logistic model. Three sites with < 10 patients were excluded from the model. For 15 sites (75%), the model predicted long durations with >75% accuracy. Table 2 provides average duration each variable contributes to evaluation by site. Those highlighted in green indicate shortest durations compared to other groups.

Conclusions: Duration of pre-surgical evaluation for DRE can be accurately modeled using multiple patient characteristics and testing strategies commonly employed in epilepsy surgery evaluations. This predictive model can not only estimate evaluation duration, but also identify opportunities to improve systemic efficiency. Institution level modeling identifies specific program strengths providing opportunity to learn from successful processes. Subsequent research will focus on institutional process mapping to better understand systemic practices leading to improved efficiencies, then sharing these processes across the consortium to shorten evaluation durations.

Funding: none

Surgery