First, I would like to extend my gratitude to the organizers of the 2020 American Association of Neurological Surgeons Annual Meeting for the opportunity to share our work with you today. Our study is titled Assessing the Incidence and Burden of Post-Neurosurgical Antidepressive Use in Children Undergoing Surgery for Refractory Seizures. We have no relevant disclosures related to this study. Children following major operations is a known risk. Studies have established its negative impact on quality of life across a spectrum of surgeries, including but not limited to cardiac, abdominal, and gynecologic operations. Notably, the incidence of post-neurosurgical depression is extremely high, with some studies estimating as many as 10% of patients develop depressive symptoms. Despite this, there are few studies evaluating post-operative depression in the pediatric neurosurgery population, particularly in children with refractory seizures previously subjected to significant courses of medication. Understanding the risk factors associated with post-operative depression remains of high importance. Our project goals are as follows. We sought to use a large nationally sourced data set to understand the risk of depression following neurosurgical treatment of recurrent seizures in children. To do this, we used new prescriptions of antidepressants to serve as a proxy for clinically relevant depression. We additionally sought to characterize the risk factors associated with post-neurosurgical depression in this population. Our full cohort of pediatric epilepsy patients contain nearly 27,000 children sourced from the IBM Watson Health Market Scan Claims Database. However, of these, only 1,054 received neurosurgical treatment. Median length of continuous post-neurosurgical follow-up was 21 months, and nearly 60% of patients received either lesionectomy or temporal lobectomy. The plot on the right depicts trends in antidepressant prescribing in the 90 days and 365 days following epilepsy diagnosis. For both time intervals, we see significantly increasing antidepressant use over the time period between 2007 and 2016. In patients receiving neurosurgical treatment, the most frequently prescribed antidepressant was fluoxetine, followed by sertraline. The plot on the right explores trends in utilization of the five antidepressants labeled in the pie chart. The bold-faced font in the legend indicates statistical significance, with fluoxetine and sertraline being used more frequently over time, while amitriptyline has seen decreases in usage. When assessing univariable comparisons, we noticed incidence of antidepressant use was significantly higher in patients receiving surgery than in those not receiving surgery. However, there was no difference in incidence of antidepressant use when stratifying by procedure type. In the multivariable Cox regression model, considering patient and hospitalization-specific factors, three features were identified as being independently associated with postneurosurgical antidepressant use. These are described here, along with the multivariable hazard ratios and associated 95% confidence interval. Furthermore, we compared risk of postneurosurgical antidepressant use in patients receiving single surgeries with those receiving multiple surgeries, and did not observe a significant difference in incidence. However, poor postneurosurgical seizure control was associated with increased antidepressant use. The plot on the right stratifies patients based on the number of antiepileptics actively being taken six months after surgery. Those taking three or more antiepileptic drugs concurrently at this point in time were at significantly increased risk of postneurosurgical depression. In our study, we identified history of antidepressant use, longer hospitalizations, and older age as risk factors for postneurosurgical depression. Using the number of active postneurosurgical antiepileptic prescriptions, we demonstrate poor seizure control after surgery is an important risk factor for depression. Overall, our study suggests risk of depression may be elevated in children receiving surgery for recurrent seizures compared to their non-surgical counterparts. At this point, I would like to thank all of the co-authors, and in particular Dr. Gerald Grant, for their contributions and mentorship. Additionally, this project would not have been possible without the support of the Stanford Center for Population Health Sciences. Again, thank you to the organizers of the 2020 AANS Annual Meeting for the opportunity to share our work with you today.

post-neurosurgical antidepressant use

refractory seizures

pediatric neurosurgery

risk factors

depression