Abstracts

Resective surgery for refractory epilepsy has beneficial impacts on seizure occurrence and on health-related quality of life. However, patients[rsquo] perceptions of the impact of surgery and their willingness to undergo surgery if they had that decision to make again, as well as determinants of those perceptions, are key outcomes to consider in evaluating a highly invasive elective procedure. Large, prospective studies to evaluate satisfaction are lacking. At 7 US centers, 396 adolescents and adults were enrolled in an observational cohort study and underwent resective surgery for refractory epilepsy. Data were collected by interview and medical record review at baseline (except satisfaction) and at 3, 12, and 24 months after surgery. Satisfaction measures obtained included: (1) overall impact of surgery, and (2) willingness to undergo surgery if he/she had that decision to make again. Data were analyzed using multivariate ordered logistic regression, adjusted for clustering by site. Seizure freedom, change in employment, temporal vs. extra-temporal resection, gender, complications at discharge, age, epilepsy duration, and side of surgery were assessed for associations with each satisfaction measure. The majority of patients at 3 (n=356), 12 (n=354), and 24 (n=318) months reported a very strong positive overall impact (51.5%, 58.7%, and 59.3%, respectively); a minority reported a negative impact (4.4%, 5.1%, 3.4%, respectively). A large majority of subjects at months 3, 12, and 24 would definitely do it all over again (73.8%, 77.4%, 75.5%); a minority would not (3.3%, 4.8%, 6.6%). Multivariate modeling showed that being completely seizure free since surgery was associated with more positive perceptions of both satisfaction measures at each time point (all p[lt]0.04). Improved employment status was also generally associated with higher satisfaction at 12 and 24 months, although fewer than 15% of patients had an improved employment status. Right-sided resection (at 12 and 24 months) and female gender (at 3 and 12 months) were each positively associated with overall impact. Surgery type, age, epilepsy duration, and discharge complications were not associated with either satisfaction measure. A large majority of this cohort who had resective epilepsy surgery reported a strong positive impact of surgery and would [quot]do it all over again.[quot] Over time, seizure freedom and improved employment were consistently associated with satisfaction, but only a small proportion became regularly employed. Although these associations are not necessarily causal, they suggest that efforts to re-integrate these patients into employment should be enhanced. (Supported by NIH R01 NS 32375; RWJ Foundation)