TY - JOUR
T1 - The effect of epilepsy surgery on productivity
T2 - A systematic review and meta-analysis
AU - Siriratnam, Pakeeran
AU - Foster, Emma
AU - Shakhatreh, Lubna
AU - Neal, Andrew
AU - Carney, Patrick W.
AU - Jackson, Graeme D.
AU - O'Brien, Terence J.
AU - Kwan, Patrick
AU - Chen, Zhibin
AU - Ademi, Zanfina
N1 - Funding Information:
P. Siriratnam has no relevant disclosures. E. Foster has been supported by grants from the National Health and Medical Research Council (NHMRC) Medical Postgraduate Research Scholarship (APP1150482), The Royal Australasian College of Physicians Research Entry Scholarship, Avant Doctors In Training Scholarship, and Monash University Bridging Postdoctoral Fellowship, and she/her institution has also received research grants from Brain Foundation and the Australian Epilepsy Research Fund, outside the submitted work. L. Shakhatreh has no relevant disclosures. A. Neal has no relevant disclosures. P.W. Carney has no relevant disclosures. G.D. Jackson is supported by The Australian Epilepsy Project, which received funding from the Australian Government under the Medical Research Future Fund. T.J. O'Brien is supported by a NHMRC Investigator Grant (APP1176426), and his institution has received consultancy fees and/research grants from UCB Pharma, Eisai, Biogen, Praxis Pharmaceuticals, ES Therapeutics, and Supernus Pharmaceuticals. P. Kwan is supported by The Australian Epilepsy Project, which received funding from the Australian Government under the Medical Research Future Fund. Z. Chen is supported by an Early Career Fellowship from the NHMRC of Australia (GNT1156444), and he/his institution has received consultancy fees and/or research grants from Arvelle Therapeutics and UCB Pharma. Z. Ademi is supported by The Australian Epilepsy Project, which received funding from the Australian Government under the Medical Research Future Fund. The authors report no targeted funding.
Publisher Copyright:
© 2022 International League Against Epilepsy
PY - 2022/4
Y1 - 2022/4
N2 - Objectives: An important but understudied benefit of resective epilepsy surgery is improvement in productivity; that is, people's ability to contribute to society through participation in the workforce and in unpaid roles such as carer duties. Here, we aimed to evaluate productivity in adults with drug-resistant epilepsy (DRE) pre- and post-resective epilepsy surgery, and to explore the factors that positively influence productivity outcomes. Methods: We conducted a systematic review and meta-analysis using four electronic databases: Medline (Ovid), EMBASE (Ovid), EBM Reviews - Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Library. All studies over the past 30 years reporting on pre- and post-resective epilepsy surgical outcomes in adults with DRE were eligible for inclusion. Meta-analysis was performed to assess the post-surgery change in employment outcomes. Results: A total of 1005 titles and abstracts were reviewed. Seventeen studies, comprising 2056 unique patients, were suitable for the final quantitative synthesis and meta-analysis. Resective epilepsy surgery resulted in a 22% improvement in overall productivity (95% confidence interval [CI]: 1.07–1.40). The factors associated with increased post-surgery employment risk ratios were lower pre-surgical employment in the workforce (relative risk ratio [RRR] =0.34; 95% CI: 0.15–0.74), shorter follow-up duration (RRR = 0.95; 95% CI: 0.90–0.99), and lower mean age at time of surgery (RRR= 0.97; 95% CI: 0.94–0.99). The risk of bias of the included studies was assessed using Risk Of Bias In Non-randomised Studies - of Interventions and was low for most variables except ”measurement of exposure.”. Significance: There is clear evidence that resective surgery in eligible surgical DRE patients results in improved productivity. Future work may include implementing a standardized method for collecting and reporting productivity in epilepsy cohorts and focusing on ways to reprioritize health care resource allocation to allow suitable candidates to access surgery earlier. This will ultimately benefit individuals with DRE, their families, our communities, and the wider health care system.
AB - Objectives: An important but understudied benefit of resective epilepsy surgery is improvement in productivity; that is, people's ability to contribute to society through participation in the workforce and in unpaid roles such as carer duties. Here, we aimed to evaluate productivity in adults with drug-resistant epilepsy (DRE) pre- and post-resective epilepsy surgery, and to explore the factors that positively influence productivity outcomes. Methods: We conducted a systematic review and meta-analysis using four electronic databases: Medline (Ovid), EMBASE (Ovid), EBM Reviews - Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Library. All studies over the past 30 years reporting on pre- and post-resective epilepsy surgical outcomes in adults with DRE were eligible for inclusion. Meta-analysis was performed to assess the post-surgery change in employment outcomes. Results: A total of 1005 titles and abstracts were reviewed. Seventeen studies, comprising 2056 unique patients, were suitable for the final quantitative synthesis and meta-analysis. Resective epilepsy surgery resulted in a 22% improvement in overall productivity (95% confidence interval [CI]: 1.07–1.40). The factors associated with increased post-surgery employment risk ratios were lower pre-surgical employment in the workforce (relative risk ratio [RRR] =0.34; 95% CI: 0.15–0.74), shorter follow-up duration (RRR = 0.95; 95% CI: 0.90–0.99), and lower mean age at time of surgery (RRR= 0.97; 95% CI: 0.94–0.99). The risk of bias of the included studies was assessed using Risk Of Bias In Non-randomised Studies - of Interventions and was low for most variables except ”measurement of exposure.”. Significance: There is clear evidence that resective surgery in eligible surgical DRE patients results in improved productivity. Future work may include implementing a standardized method for collecting and reporting productivity in epilepsy cohorts and focusing on ways to reprioritize health care resource allocation to allow suitable candidates to access surgery earlier. This will ultimately benefit individuals with DRE, their families, our communities, and the wider health care system.
UR - http://www.scopus.com/inward/record.url?scp=85123704118&partnerID=8YFLogxK
U2 - 10.1111/epi.17172
DO - 10.1111/epi.17172
M3 - Article
C2 - 35088411
AN - SCOPUS:85123704118
SN - 0013-9580
VL - 63
SP - 789
EP - 811
JO - Epilepsia
JF - Epilepsia
IS - 4
ER -