Complications from vagus nerve stimulator (VNS) procedures are common and can have important implications for morbidity and seizure control, yet predictors of complications are poorly understood. The objective of this study was to assess clinical factors associated with minor and major complications from VNS procedures among pediatric patients with drug-resistant epilepsy.

The authors performed an 11-year retrospective review of patients who underwent VNS procedures for drug-resistant epilepsy at age < 21 years. The primary outcome was complications (minor or major) following VNS surgery. Preoperative and surgery characteristics were compared between patients who developed versus those who did not develop complications. Multivariable Poisson regression was performed to determine the association between preoperative characteristics and infection.

Of 686 surgeries, 48 complications (7.0%) developed; there were 7 minor complications (1.0%) and 41 major complications (6.0%). Surgeries with minor complications were an average of 68 minutes longer than those without minor complications (p < 0.001). The incidence rate of infection was 1 per 100 person-years, with 3% of procedures complicated by infection. Poisson regression revealed that after adjusting for age at surgery, duration of surgery, and primarily motor seizure semiology, the incident rate of infection for revision surgeries preceded by ≥ 2 procedures was 19 times that of first-time revisions.

The overall minor complication rate was 1% and the overall major complication rate was 6% for VNS procedures. Longer surgery duration was associated with the development of minor complications but not major complications. Repeat incisions to the VNS pocket may be associated with higher incident rate of infection, highlighting a need for longer-lasting VNS pulse generator models.

迷走神经刺激器 (VNS) 手术的并发症很常见，可能对发病率和癫痫控制产生重要影响，但人们对并发症的预测因素知之甚少。本研究的目的是评估与耐药性癫痫儿科患者 VNS 手术引起的轻微和主要并发症相关的临床因素。

作者对 21 岁以下因耐药性癫痫接受 VNS 手术的患者进行了 11 年的回顾性研究。主要结局是 VNS 手术后的并发症（轻微或严重）。对出现并发症的患者与未出现并发症的患者的术前和手术特征进行比较。进行多变量泊松回归以确定术前特征与感染之间的关联。

在 686 例手术中，出现了 48 例并发症 (7.0%)；轻微并发症 7 例（1.0%），严重并发症 41 例（6.0%）。有轻微并发症的手术比没有轻微并发症的手术平均长 68 分钟 (p < 0.001)。感染发生率为每100人年1例，其中3%的手术并发感染。泊松回归显示，调整手术年龄、手术持续时间和主要运动性癫痫症状学后，进行≥2次手术的翻修手术的感染发生率是首次翻修的19倍。

VNS 手术的总体轻微并发症发生率为 1%，总体主要并发症发生率为 6%。较长的手术时间与轻微并发症的发生有关，但与严重并发症无关。 VNS 袋的重复切口可能与较高的感染发生率相关，这凸显了对更持久的 VNS 脉冲发生器模型的需求。