Vagal Nerve Stimulation for Epilepsy in Adults: A Database Risk Analysis and Review of the Literature

BACKGROUND: Epilepsy is one of the most common neurologic disorders and often remains refractory despite pharmacologic treatment. In patients who are not amenable to surgical resection of seizure foci, vagal nerve stimulation (VNS) may be beneficial. Multiple case series have attempted to construct a risk profile for VNS, but they are largely confined to pediatric or single-center populations. We aimed to compile a risk profile for adults undergoing VNS, using multicenter patient data from an international database. METHODS: The 30-day outcomes of adults undergoing VNS from 2005 to 2016 were collected from the American College of Surgeons National Surgical Quality Improvement Program database. Readmission rates, reoperation rates, length of hospital stay, operative time, and complications were assessed. A comprehensive literature search was performed to identify historically reported complication rates. RESULTS: Inclusion and exclusion criteria were met by 77 patients. A 30-day risk profile revealed low readmission (6.2%), reoperation (1.3%), and postoperative infection (1.3%) rates. Mean operative time was 81.7 minutes, and average length of stay was 0.27 days. Most (87.0%) patients were discharged on the day of operation. CONCLUSIONS: This study provides a current snapshot of risks and outcomes in VNS, revealing a safe 30-day risk profile. Greater use of VNS may be beneficial in this fragile population.