Researchers Identify Factors That Influence Patient Outcome After Deep Brain Stimulation (DBS)
Several factors contribute to the outcome of patients with Parkinson’s disease who undergo deep brain stimulation (DBS), according to a new study.
The research paper, “Short-term Adverse Outcomes Following Deep Brain Stimulation Treatment in Parkinson’s Disease Patients,” was published in the journal World Neurosurgery.
DBS is a surgical procedure given to patients with Parkinson’s to treat their neurological symptoms and help control their movements. In this procedure, a medical device called a neurostimulator is implanted in the brain to deliver electrical stimulation to the areas that control movement, thereby regulating nerve signals that cause tremors and other symptoms.
This treatment usually is recommended for patients whose symptoms are relapsing or worsening, and may be a useful complement to medication.
However, as with other types of surgery, there are certain adverse outcomes that can occur shortly after DBS treatment.
The objective of the study was to identify risk factors associated with 30-day outcomes following DBS treatment in patients with Parkinson’s disease.
Researchers analyzed the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, which contains data from several patients with Parkinson who underwent DBS from 2005 to 2014. Data were collected from these patients for the entire 30-day post-operative period, regardless of their discharge date, and included information on several factors related to the patients. Those factors included age, gender, body mass index, functional status (whether the patient was independent or dependent), transfer status (if the patient was sent home or transferred to another health unit), selected pre-operative parameters (anemia), or presence of other medical conditions. Researchers also analyzed risk factors associated with the surgery itself, such as type of anesthesia and duration.
The team found that 650 Parkinson’s patients underwent DBS procedures, of which 32 (4.9%) presented post-operative complications. Such complications were mainly urinary tract infections, but systemic complications, superficial wound infections or new surgical interventions also were reported.
Of the 481 patients who had complete discharge data, 18 patients (3.7%) were transferred to a facility, whereas 16 patients (3.3 %) were readmitted to the hospital.
Obesity, anemia and longer surgery duration were the factors found to be associated with a high risk of developing post-operative complications.
Also, factors such as inpatient status, dependent functional status and anemia were associated with discharge to a facility rather than home. Although most patients were discharged home, predictors of discharge to other facilities included inpatient status, anemia, dependent functional status and any postoperative complication.
Unplanned readmission in the hospital was significantly associated with factors such as longer operative duration, anemia and dependent functional status. As expected, complications increased the likelihood of unplanned readmission.
“[O]ptimal preoperative and peri-operative management of DBS treatment for PD patients should include screening for anemia, obesity, and UTI,” the authors wrote. “Reduced DBS procedure time can also limit short-term adverse outcomes. Finally, planning for a likely discharge to a facility in high-risk patients can facilitate the transition from the hospital setting and potentially reduce the likelihood of readmission. Patients who are likely to have post-operative complications may also benefit from closer surveillance and follow-up within the first 30 days following discharge,” the study concluded.