Introduction: Neurosurgery is essential for epilepsy patients unresponsive to medication, yet lower-income and minority groups often face access barriers. This study investigates the impact of socioeconomic status (SES) on hospital length of stay (LOS), admission costs, and discharge disposition for these patients.
Methods: We identified intractable epilepsy patients who underwent open surgery, laser interstitial thermal therapy (LITT), vagus nerve stimulation (VNS), or responsive neurostimulation (RNS) using the 2016-2019 National Inpatient Sample. Patients were grouped into quartiles based on zip code median household income as an SES proxy. We compared patient demographics and hospital characteristics across SES groups. Multivariable logistic regression analysis identified factors associated with extended LOS, high admission costs, and non-routine discharge.
Results: Among the 1,992 patients, 446 (22.4%) were in the lowest income quartile, 534 (26.8%) in the second, 538 (27.0%) in the third, and 474 (23.8%) in the highest. The highest quartile was predominantly non-Hispanic White (71.5%) and privately insured (68.8%). RNS occurred more commonly in the highest quartile (16.0%) than the lowest (11.4%) (p = 0.051) and was higher among non-Hispanic Whites (14.0%) than Hispanics (11.9%) and other races (9.1%) (p = 0.007). Multivariable analysis showed no significant differences between income quartiles for predicting extended LOS, high admission costs, or non-routine discharge. LITT (adjusted OR: 0.14, 95% CI: 0.07-0.28), VNS (aOR: 0.23, 95% CI: 0.15-0.35), and RNS (aOR: 0.21, 95% CI: 0.13-0.34) had lower odds of extended LOS compared to open surgery. RNS (aOR: 2.56, 95% CI: 1.90-3.45) was significantly associated with higher admission cost. Non-Hispanic Black (aOR: 1.63, 95% CI: 1.05-2.53) and Other race (aOR: 1.72, 95% CI: 1.05-2.80) were significantly associated with higher odds of non-routine discharge.
Conclusion : Although immediate surgical outcomes and costs were similar across income levels, lower-income and Hispanic patients received RNS less commonly, highlighting a socioeconomic disparity in epilepsy surgery. Further research on surgical barriers and long-term outcomes is needed to ensure equitable epilepsy care.
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