Abstracts

Rationale:
Delayed discharge has a great impact on patients, their families, healthcare staff, and hospital costs. Identifying the predictor or risk factors will help predict unexpected delayed discharge and prevent patients, their families, healthcare staff, and hospital costs from unexpected burdens. This study aimed to identify the risk factors for delayed discharges in patients who underwent curative epilepsy surgery.




Methods:
This single-center retrospective study evaluated 70 consecutive cases (age median: 34; range: 14-59) of patients who underwent their first curative epilepsy surgery from 2018 to 2023. Delayed discharge was defined as an extension beyond the scheduled hospitalization period. We extracted clinical information (age at surgery, duration of epilepsy, MRI lesional case or not, number of anti-seizure medications, comorbidity of developmental delay, comorbidity of psychological disorders, number of previous intracranial surgeries, affected hemisphere side, and affected brain lobe), histopathological findings, and whether patients had experienced delayed discharges or not from medical records. We employed the univariable logistic regression analysis to determine the associated clinical or histopathological factors with the outcome.




Results:
A total of 17 patients (24.3%) experienced delayed discharges following epilepsy surgery. The causes of delays included surgical-site infections (n=4), temporary neurological deficits (n=9), acute brief psychosis (n=1), difficulties arising from headaches or loss of appetite (n=2), and nonconvulsive status epilepticus (n=1). Univariable logistic regression analysis identified significant risk factors for delayed discharge: the number of previous intracranial surgeries (odds ratio [OR]: 3.40; 95% confidence interval [CI]: 1.02-11.34; p-value: 0.046) and the histopathological findings of mild malformations of cortical development (other than focal cortical dysplasia) (OR: 3.36; 95% CI: 1.06-10.6; p-value: 0.039). Conversely, undergoing surgery for temporal lobe epilepsy significantly reduced the risk of delayed discharge (OR: 0.19; 95% CI: 0.06-0.63; p-value: 0.006).




Conclusions:
This study successfully identified significant risk factors for delayed discharge following curative epilepsy surgery. Our findings suggest that: (1) A higher number of previous intracranial surgeries may increase the risk of surgical-site infections, potentially leading to extended hospital stays. (2) Patients displaying histopathological signs of mild malformations of cortical development, other than focal cortical dysplasia, may require more extensive brain resections, increasing the likelihood of postoperative neurological deficits. (3) Surgeries targeting temporal lobe epilepsy, being more common and familiar to physicians, tend to be associated with fewer complications and shorter hospital stays, compared to surgeries for other types of epilepsy. These insights highlight the importance of tailored perioperative management based on individual surgical history and histopathological findings.




Funding: non