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Rehospitalization following vagal nerve stimulator implant

Rehospitalization following vagal nerve stimulator implant. Paul Kalanithi, MD, Bob Arrigo, BS, Maxwell Boakye, MD, FACS Outcomes Research Center Stanford University Department of Neurosurgery. Disclosures: None. VNS FOR EpiLEPSY.

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Rehospitalization following vagal nerve stimulator implant

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  1. Rehospitalization following vagal nerve stimulator implant Paul Kalanithi, MD, Bob Arrigo, BS, Maxwell Boakye, MD, FACS Outcomes Research Center Stanford University Department of Neurosurgery Disclosures: None

  2. VNS FOR EpiLEPSY • Only 1 prior large database study on vagal nerve stimulation – only inpatient • Rehospitalization rates likely to become quality measure • This study provides California data regarding 1 year follow-up data on rehospitalization rates, frequency, charges and complications of vagal nerve stimulation for epilepsy

  3. METHODS • Data Source • Healthcare Cost and Utiliation Project’s California State Inpatient Databases (CA-SID), Ambulatory Surgery Database • collects ICD-9, CPT, and other administrative data on hospitalizations in California • HCUP verification for longitudinal analysis • Inclusion/Exclusion criteria • All patients from 2005-2007 with: • With primary procedure codes for ICD-9 04.92, 04.93, 86.94, 86.05; CPT 64573, 61885, 64585, 61888 • Primary diagnosis code for epilepsy ICD-9 345.x • Variables: age, co-morbidity, gender, race, hospital size, county, • Outcomes: 1 year rehospitalizations and reoperations, 30 day complications, mortality, suicide rates

  4. Statistical Analysis • Predictors of in-hospital complication and adverse disposition were identified using a univariate and multivariate logistic regression model. • P-value < 0.05 or odds ratio excluding 1.00 were accepted as significant

  5. Data overview

  6. LOW COMPLICATIONS, MORTALITY 30 Day Complications: 0.4% - 1 pulmonary event 30 Day Mortality: 0%

  7. REHOSPITALIZATION RATES • One year rehospitalization rates: • 118 • 45% • One Year Suicide Attempt Rate: • 1.8%

  8. REOPERATION RATES • One year reoperation rate: 5.7% • VNS system removals: 5 • IPG replacements: 6 • IPG removals: 4 • Diagnoses: Infection 2.7% Device Failure 1.5%

  9. Methodologic weaknesses • Only assesses mortality/suicide from clinical settings • Cannot assess decision for operation/other clinical factors • Limitations of ICD-9/CPT codes • No functional outcomes

  10. SUMMARY • VNS overall a very safe procedure • Rehospitalization rates comparable to other procedures • Reoperation rates 5.7% at 1 year • HCUP databases can be used for longitudinal data across multiple care delivery settings

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