Surgical Complications and Admission Rates After Vagus Nerve Stimulation in Children

Introduction: Vagus Nerve Stimulation (VNS) is an established therapy for drug-resistant epilepsy. While generally considered safe, surgical complications associated with device implantation can occur. Previous large studies have reported non-zero rates of infection and device explantation. This study aims to evaluate the surgical complication profile in a large, single-center, single-surgeon pediatric VNS cohort.

Methods: A retrospective review of 191 pediatric patients (age 19 or under) who underwent VNS implantation by the senior author at Children’s Hospital of Philadelphia was conducted. Patient data were collected through 90 days pre- and post-procedure, including admissions, emergency room visits, neurology and neurosurgery office visits, and phone encounters. Specific complications, such as hoarseness, cough, fever, and hematoma were recorded and quantified. Changes in the frequency of admissions and emergency room visits were compared pre- and post-procedure, with a subanalysis focused on seizure-related events.

Results: There were zero cases of infection or explantation. Cough occurred in 9 patients, temporary hoarseness in 4 patients, operative wound dehiscence in 1 patient, non-operative chest hematoma in 1 patient. There was a statistically significant decrease in hospital admissions 90 days after the procedure compared to 90 days before the procedure (0.224 vs 0.375 per patient, p-value = 0.004382), and a decrease in total seizure-related admissions (0.068 vs 0.245 per patient, p-value = 1.027e-05). There were no significant differences in ER visits or admissions 30-day pre- vs post- comparisons.

Conclusion : This single-center, single-surgeon study demonstrates a favorable surgical complication profile for pediatric VNS implantation, with zero reported cases of infection or device explantation. While further long-term follow-up is necessary, these findings suggest that a standardized, high-volume approach to VNS surgery may contribute to reduced complication rates. Furthermore, the benefit of VNS in children may be seen within 90 days as reduction in admissions and seizure-related admissions.