Feasibility and safety of same-day discharge after paediatric vagus nerve stimulator implantation for medically intractable epilepsy: a retrospective safety analysis.

OBJECTIVE: Vagal nerve stimulation (VNS) is an established adjunctive treatment for children with medically intractable epilepsy. It is common practice to admit these children overnight for observation due to concern of airway compromise and other medical complications. We wanted to determine the safety of vagal nerve stimulator insertion in the immediate peri-operative period to determine if same-day discharge is feasible and safe in children. METHODS: We conducted a retrospective review of all paediatric patients (age less than 19 years of age) who underwent vagal nerve stimulator (VNS) implantation at our institution between January 2002 and December 2022. RESULTS: In total, 197 patients were included in the analysis. Mean age at surgery was 11.1 years (SD 4.1). Median length of stay was 1 day (IQR 1-1); 21 children (10.7%) were discharged the same day. There were no intraoperative complications. No child (0%) had an immediate postoperative surgical complication. Three children had postoperative medical complications (1.5%), all of which occurred in the first hour after surgery. Developmental delay was present in 95% of documented cases. CONCLUSIONS: These findings support the safety of same-day discharge in appropriately selected patients, with structured criteria and parental guidance.