National trends of Laser interstitial thermal therapy (LITT) and Vagus Nerve stimulation (VNS) for refractory epilepsy in adult patients: A Nationwide Inpatient Sample based propensity score matched analysis

Objective: The aim of our study was to report the national trends of Vagus nerve stimulation (VNS) and Laser interstitial thermal therapy (LITT) and compare their outcomes in patients with medically refractory epilepsy (RE). Methods: Nationwide Inpatient Sample database (NIS, 1998–2018) was used to extract the data using the ICD-9/10 codes. Adult patients (>18 years) with a primary diagnosis of RE who underwent either VNS or LITT were included. Patient demographics, complications, length of hospital stay (LOS), discharge disposition and index-hospitalization costs were analyzed. Results: A cohort of 226,248 patients with RE were included, of which only 0.66 % underwent VNS (n = 1500) and 0.34 % (n = 770) underwent LITT. VNS accounted for 66 % of the surgical procedures. The use of LITT gradually increased from 2012 (0.69/1000 RE cases) to 2018 (4.43/1000 RE cases) compared to VNS (2012: 9.85/1000 RE to 2018: 5.31/1000 RE cases). Median age was similar across the cohorts (LITT: 38 years; VNS: 36 years, p = 0.33). Index hospitalization median charges were significantly lower following LITT compared to VNS (LITT: $ 115,838; VNS: $ 131,984, p < 0.0033). No differences in terms of median LOS, discharge to home, complications and median index hospitalization charges were noted between the procedures (LITT vs. VNS). Conclusion: LITT is increasingly being performed for RE with decreasing trends for VNS. The complications profile was similar among both the procedures. Both LITT and VNS are minimally invasive and safe treatment modalities in carefully selected patients with RE.