Surgical Epilepsy Care in a Safety-Net and Private Healthcare System: A Comparative Analysis

Abstract

Abstract INTRODUCTION Access to and delivery of quality surgical epilepsy care remains a challenge in both safety-net and private hospital systems. Underserved populations are more likely to utilize safety-net hospital systems, but to date there have been no published reports on epilepsy surgery outcomes in this setting. This study aimed to prospectively analyze and compare surgical epilepsy care in a safety-net versus private hospital system. METHODS We prospectively collected evaluation and treatment data in patients undergoing resective surgery for refractory epilepsy at the multi-institutional Los Angeles County Department of Health Services Comprehensive Epilepsy Program between 2010 and 2017. Seizure characteristics, pre-surgical evaluation, perioperative complications, and postsurgery seizure outcomes as measured by the Engel classification were recorded. This cohort was compared to patients treated in a private hospital system with which it collaborated during the same time period. RESULTS Data from 102 patients in the safety-net and 145 patients in the private hospital system were analyzed. There was a higher proportion of African American (P = .02) and Hispanic patients (P = .03) in the safety-net hospital system. There was no difference in mean time from epilepsy onset to surgery between groups (P = .54). The presurgical evaluation was equivalent (P > .18), except for more frequent use of magnetoencephalography in the private system (P = .02). Seizure freedom outcomes were excellent, and complication rates were low with no difference between groups (P = .95 and P > .22, respectively). However, patients from safety-net hospital systems were more likely to be lost to follow up (P = .04). CONCLUSION Quality surgical epilepsy care can be delivered in a safety-net hospital system and intrinsic factors of safety-net hospital do not limit quality. Partnership of safety-net hospital systems with established comprehensive epilepsy centers is essential for the delivery of quality surgical epilepsy care. The expansion of these services is vital for providing modern epilepsy care for the underserved population.