Defining benchmark outcomes for mesial temporal lobe epilepsy surgery: A global multicenter analysis of 1119 cases

Richard Drexler; Franz L Ricklefs; Sharona Ben-Haim; Anna Rada; Friedrich Wörmann; Thomas Cloppenborg; Christian G Bien; Matthias Simon; Thilo Kalbhenn; Albert Colon; Kim Rijkers; Olaf Schijns; Valeri Borger; Rainer Surges; Hartmut Vatter; Michele Rizzi; Marco de Curtis; Giuseppe Didato; Nicoló Castelli; Alexandre Carpentier; Bertrand Mathon; Clarissa Lin Yasuda; Fernando Cendes; Poodipedi Sarat Chandra; Manjari Tripathi; Hans Clusmann; Daniel Delev; Marc Guenot; Claire Haegelen; Hélène Catenoix; Johannes Lang; Hajo Hamer; Sebastian Brandner; Katrin Walther; Jason S Hauptmann; Rosalind L Jeffree; Josua Kegele; Eliane Weinbrenner; Georgios Naros; Julia Velz; Niklaus Krayenbühl; Julia Onken; Ulf C Schneider; Martin Holtkamp; Karl Rössler; Andrea Spyrantis; Adam Strzelczyk; Felix Rosenow; Stefan Stodieck; Mario A Alonso-Vanegas; Et al.

doi:10.1111/epi.17923

Defining benchmark outcomes for mesial temporal lobe epilepsy surgery: A global multicenter analysis of 1119 cases

Richard Drexler^*, Franz L Ricklefs, Sharona Ben-Haim, Anna Rada, Friedrich Wörmann, Thomas Cloppenborg, Christian G Bien, Matthias Simon, Thilo Kalbhenn, Albert Colon, Kim Rijkers, Olaf Schijns, Valeri Borger, Rainer Surges, Hartmut Vatter, Michele Rizzi, Marco de Curtis, Giuseppe Didato, Nicoló Castelli, Alexandre CarpentierBertrand Mathon, Clarissa Lin Yasuda, Fernando Cendes, Poodipedi Sarat Chandra, Manjari Tripathi, Hans Clusmann, Daniel Delev, Marc Guenot, Claire Haegelen, Hélène Catenoix, Johannes Lang, Hajo Hamer, Sebastian Brandner, Katrin Walther, Jason S Hauptmann, Rosalind L Jeffree, Josua Kegele, Eliane Weinbrenner, Georgios Naros, Julia Velz, Niklaus Krayenbühl, Julia Onken, Ulf C Schneider, Martin Holtkamp, Karl Rössler, Andrea Spyrantis, Adam Strzelczyk, Felix Rosenow, Stefan Stodieck, Mario A Alonso-Vanegas, Et al.

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVE: Benchmarking has been proposed to reflect surgical quality and represents the highest standard reference values for desirable results. We sought to determine benchmark outcomes in patients after surgery for drug-resistant mesial temporal lobe epilepsy (MTLE). METHODS: This retrospective multicenter study included patients who underwent MTLE surgery at 19 expert centers on five continents. Benchmarks were defined for 15 endpoints covering surgery and epilepsy outcome at discharge, 1?year after surgery, and the last available follow-up. Patients were risk-stratified by applying outcome-relevant comorbidities, and benchmarks were calculated for low-risk ("benchmark") cases. Respective measures were derived from the median value at each center, and the 75th percentile was considered the benchmark cutoff. RESULTS: A total of 1119 patients with a mean age (range) of 36.7 (1-74) years and a male-to-female ratio of 1:1.1 were included. Most patients (59.2%) underwent anterior temporal lobe resection with amygdalohippocampectomy. The overall rate of complications or neurological deficits was 14.4%, with no in-hospital death. After risk stratification, 377 (33.7%) benchmark cases of 1119 patients were identified, representing 13.6%-72.9% of cases per center and leaving 742 patients in the high-risk cohort. Benchmark cutoffs for any complication, clinically apparent stroke, and reoperation rate at discharge were =24.6%, =.5%, and =3.9%, respectively. A favorable seizure outcome (defined as International League Against Epilepsy class I and II) was reached in 83.6% at 1?year and 79.0% at the last follow-up in benchmark cases, leading to benchmark cutoffs of =75.2% (1-year follow-up) and =69.5% (mean follow-up of 39.0?months). SIGNIFICANCE: This study presents internationally applicable benchmark outcomes for the efficacy and safety of MTLE surgery. It may allow for comparison between centers, patient registries, and novel surgical and interventional techniques.

Original language	English
Journal	Epilepsia
DOIs	https://doi.org/10.1111/epi.17923
Publication status	E-pub ahead of print - 24 Feb 2024

Keywords

benchmarking
neurosurgery
outcome
quality
seizure

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10.1111/epi.17923Licence: CC BY-NC

Cite this

Drexler, R., Ricklefs, F. L., Ben-Haim, S., Rada, A., Wörmann, F., Cloppenborg, T., Bien, C. G., Simon, M., Kalbhenn, T., Colon, A., Rijkers, K., Schijns, O., Borger, V., Surges, R., Vatter, H., Rizzi, M., de Curtis, M., Didato, G., Castelli, N., ... Et al. (2024). Defining benchmark outcomes for mesial temporal lobe epilepsy surgery: A global multicenter analysis of 1119 cases. Epilepsia. Advance online publication. https://doi.org/10.1111/epi.17923

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title = "Defining benchmark outcomes for mesial temporal lobe epilepsy surgery: A global multicenter analysis of 1119 cases",

abstract = "OBJECTIVE: Benchmarking has been proposed to reflect surgical quality and represents the highest standard reference values for desirable results. We sought to determine benchmark outcomes in patients after surgery for drug-resistant mesial temporal lobe epilepsy (MTLE). METHODS: This retrospective multicenter study included patients who underwent MTLE surgery at 19 expert centers on five continents. Benchmarks were defined for 15 endpoints covering surgery and epilepsy outcome at discharge, 1?year after surgery, and the last available follow-up. Patients were risk-stratified by applying outcome-relevant comorbidities, and benchmarks were calculated for low-risk ({"}benchmark{"}) cases. Respective measures were derived from the median value at each center, and the 75th percentile was considered the benchmark cutoff. RESULTS: A total of 1119 patients with a mean age (range) of 36.7 (1-74) years and a male-to-female ratio of 1:1.1 were included. Most patients (59.2%) underwent anterior temporal lobe resection with amygdalohippocampectomy. The overall rate of complications or neurological deficits was 14.4%, with no in-hospital death. After risk stratification, 377 (33.7%) benchmark cases of 1119 patients were identified, representing 13.6%-72.9% of cases per center and leaving 742 patients in the high-risk cohort. Benchmark cutoffs for any complication, clinically apparent stroke, and reoperation rate at discharge were =24.6%, =.5%, and =3.9%, respectively. A favorable seizure outcome (defined as International League Against Epilepsy class I and II) was reached in 83.6% at 1?year and 79.0% at the last follow-up in benchmark cases, leading to benchmark cutoffs of =75.2% (1-year follow-up) and =69.5% (mean follow-up of 39.0?months). SIGNIFICANCE: This study presents internationally applicable benchmark outcomes for the efficacy and safety of MTLE surgery. It may allow for comparison between centers, patient registries, and novel surgical and interventional techniques.",

keywords = "benchmarking, neurosurgery, outcome, quality, seizure",

author = "Richard Drexler and Ricklefs, {Franz L} and Sharona Ben-Haim and Anna Rada and Friedrich W{\"o}rmann and Thomas Cloppenborg and Bien, {Christian G} and Matthias Simon and Thilo Kalbhenn and Albert Colon and Kim Rijkers and Olaf Schijns and Valeri Borger and Rainer Surges and Hartmut Vatter and Michele Rizzi and {de Curtis}, Marco and Giuseppe Didato and Nicol{\'o} Castelli and Alexandre Carpentier and Bertrand Mathon and Yasuda, {Clarissa Lin} and Fernando Cendes and Chandra, {Poodipedi Sarat} and Manjari Tripathi and Hans Clusmann and Daniel Delev and Marc Guenot and Claire Haegelen and H{\'e}l{\`e}ne Catenoix and Johannes Lang and Hajo Hamer and Sebastian Brandner and Katrin Walther and Hauptmann, {Jason S} and Jeffree, {Rosalind L} and Josua Kegele and Eliane Weinbrenner and Georgios Naros and Julia Velz and Niklaus Krayenb{\"u}hl and Julia Onken and Schneider, {Ulf C} and Martin Holtkamp and Karl R{\"o}ssler and Andrea Spyrantis and Adam Strzelczyk and Felix Rosenow and Stefan Stodieck and Alonso-Vanegas, {Mario A} and {Et al.}",

year = "2024",

month = feb,

day = "24",

doi = "10.1111/epi.17923",

language = "English",

journal = "Epilepsia",

issn = "0013-9580",

publisher = "Wiley",

}

Drexler, R, Ricklefs, FL, Ben-Haim, S, Rada, A, Wörmann, F, Cloppenborg, T, Bien, CG, Simon, M, Kalbhenn, T, Colon, A, Rijkers, K , Schijns, O, Borger, V, Surges, R, Vatter, H, Rizzi, M, de Curtis, M, Didato, G, Castelli, N, Carpentier, A, Mathon, B, Yasuda, CL, Cendes, F, Chandra, PS, Tripathi, M, Clusmann, H, Delev, D, Guenot, M, Haegelen, C, Catenoix, H, Lang, J, Hamer, H, Brandner, S, Walther, K, Hauptmann, JS, Jeffree, RL, Kegele, J, Weinbrenner, E, Naros, G, Velz, J, Krayenbühl, N, Onken, J, Schneider, UC, Holtkamp, M, Rössler, K, Spyrantis, A, Strzelczyk, A, Rosenow, F, Stodieck, S, Alonso-Vanegas, MA & Et al. 2024, 'Defining benchmark outcomes for mesial temporal lobe epilepsy surgery: A global multicenter analysis of 1119 cases', Epilepsia. https://doi.org/10.1111/epi.17923

TY - JOUR

T1 - Defining benchmark outcomes for mesial temporal lobe epilepsy surgery

T2 - A global multicenter analysis of 1119 cases

AU - Drexler, Richard

AU - Ricklefs, Franz L

AU - Ben-Haim, Sharona

AU - Rada, Anna

AU - Wörmann, Friedrich

AU - Cloppenborg, Thomas

AU - Bien, Christian G

AU - Simon, Matthias

AU - Kalbhenn, Thilo

AU - Colon, Albert

AU - Rijkers, Kim

AU - Schijns, Olaf

AU - Borger, Valeri

AU - Surges, Rainer

AU - Vatter, Hartmut

AU - Rizzi, Michele

AU - de Curtis, Marco

AU - Didato, Giuseppe

AU - Castelli, Nicoló

AU - Carpentier, Alexandre

AU - Mathon, Bertrand

AU - Yasuda, Clarissa Lin

AU - Cendes, Fernando

AU - Chandra, Poodipedi Sarat

AU - Tripathi, Manjari

AU - Clusmann, Hans

AU - Delev, Daniel

AU - Guenot, Marc

AU - Haegelen, Claire

AU - Catenoix, Hélène

AU - Lang, Johannes

AU - Hamer, Hajo

AU - Brandner, Sebastian

AU - Walther, Katrin

AU - Hauptmann, Jason S

AU - Jeffree, Rosalind L

AU - Kegele, Josua

AU - Weinbrenner, Eliane

AU - Naros, Georgios

AU - Velz, Julia

AU - Krayenbühl, Niklaus

AU - Onken, Julia

AU - Schneider, Ulf C

AU - Holtkamp, Martin

AU - Rössler, Karl

AU - Spyrantis, Andrea

AU - Strzelczyk, Adam

AU - Rosenow, Felix

AU - Stodieck, Stefan

AU - Alonso-Vanegas, Mario A

AU - Et al.

PY - 2024/2/24

Y1 - 2024/2/24

N2 - OBJECTIVE: Benchmarking has been proposed to reflect surgical quality and represents the highest standard reference values for desirable results. We sought to determine benchmark outcomes in patients after surgery for drug-resistant mesial temporal lobe epilepsy (MTLE). METHODS: This retrospective multicenter study included patients who underwent MTLE surgery at 19 expert centers on five continents. Benchmarks were defined for 15 endpoints covering surgery and epilepsy outcome at discharge, 1?year after surgery, and the last available follow-up. Patients were risk-stratified by applying outcome-relevant comorbidities, and benchmarks were calculated for low-risk ("benchmark") cases. Respective measures were derived from the median value at each center, and the 75th percentile was considered the benchmark cutoff. RESULTS: A total of 1119 patients with a mean age (range) of 36.7 (1-74) years and a male-to-female ratio of 1:1.1 were included. Most patients (59.2%) underwent anterior temporal lobe resection with amygdalohippocampectomy. The overall rate of complications or neurological deficits was 14.4%, with no in-hospital death. After risk stratification, 377 (33.7%) benchmark cases of 1119 patients were identified, representing 13.6%-72.9% of cases per center and leaving 742 patients in the high-risk cohort. Benchmark cutoffs for any complication, clinically apparent stroke, and reoperation rate at discharge were =24.6%, =.5%, and =3.9%, respectively. A favorable seizure outcome (defined as International League Against Epilepsy class I and II) was reached in 83.6% at 1?year and 79.0% at the last follow-up in benchmark cases, leading to benchmark cutoffs of =75.2% (1-year follow-up) and =69.5% (mean follow-up of 39.0?months). SIGNIFICANCE: This study presents internationally applicable benchmark outcomes for the efficacy and safety of MTLE surgery. It may allow for comparison between centers, patient registries, and novel surgical and interventional techniques.

AB - OBJECTIVE: Benchmarking has been proposed to reflect surgical quality and represents the highest standard reference values for desirable results. We sought to determine benchmark outcomes in patients after surgery for drug-resistant mesial temporal lobe epilepsy (MTLE). METHODS: This retrospective multicenter study included patients who underwent MTLE surgery at 19 expert centers on five continents. Benchmarks were defined for 15 endpoints covering surgery and epilepsy outcome at discharge, 1?year after surgery, and the last available follow-up. Patients were risk-stratified by applying outcome-relevant comorbidities, and benchmarks were calculated for low-risk ("benchmark") cases. Respective measures were derived from the median value at each center, and the 75th percentile was considered the benchmark cutoff. RESULTS: A total of 1119 patients with a mean age (range) of 36.7 (1-74) years and a male-to-female ratio of 1:1.1 were included. Most patients (59.2%) underwent anterior temporal lobe resection with amygdalohippocampectomy. The overall rate of complications or neurological deficits was 14.4%, with no in-hospital death. After risk stratification, 377 (33.7%) benchmark cases of 1119 patients were identified, representing 13.6%-72.9% of cases per center and leaving 742 patients in the high-risk cohort. Benchmark cutoffs for any complication, clinically apparent stroke, and reoperation rate at discharge were =24.6%, =.5%, and =3.9%, respectively. A favorable seizure outcome (defined as International League Against Epilepsy class I and II) was reached in 83.6% at 1?year and 79.0% at the last follow-up in benchmark cases, leading to benchmark cutoffs of =75.2% (1-year follow-up) and =69.5% (mean follow-up of 39.0?months). SIGNIFICANCE: This study presents internationally applicable benchmark outcomes for the efficacy and safety of MTLE surgery. It may allow for comparison between centers, patient registries, and novel surgical and interventional techniques.

KW - benchmarking

KW - neurosurgery

KW - outcome

KW - quality

KW - seizure

U2 - 10.1111/epi.17923

DO - 10.1111/epi.17923

M3 - Article

SN - 0013-9580

JO - Epilepsia

JF - Epilepsia

ER -