How Neuropsychiatric Comorbidity, Modulatory Indication, Demographics, and Other Factors Impact Deep Brain Stimulation Inpatient Outcomes in the United States: A Population-Based Study of 27,956 Patients
Clinical Neurology and Neurosurgery
Objective: To determine how neuropsychiatric comorbidity, modulatory indication, demographics, and other characteristics affect inpatient deep brain stimulation (DBS) outcomes.
Methods: This is a retrospective study of 45 months' worth of data from the National Inpatient Sample. Patients were aged ≥ 18 years old and underwent DBS for Parkinson Disease (PD), essential tremor (ET), general dystonia and related disorders, other movement disorder (non-PD/ET), or obsessive-compulsive disorder (OCD) at a US hospital. Primary endpoints were prolonged length of stay (PLOS), high-end hospital charges (HEHCs), unfavorable disposition, and inpatient complications. Logistic models were constructed with odds ratios under 95% confidence intervals. A p-value of 0.05 determined significance.
Results: Of 214,098 records, there were 27,956 eligible patients. Average age was 63.9 ± 11.2 years, 17,769 (63.6%) were male, and 10,182 (36.4%) patients were female. Most of the cohort was White (51.1%), Medicare payer (64.3%), and treated at a large-bed size (80.7%), private non-profit (76.9%), and metro-teaching (94.0%) hospital. Neuropsychiatric comorbidity prevalence ranged from 29.9% to 47.7% depending on indication. Compared with PD, odds of complications and unfavorable disposition were significantly higher with other movement disorders and dystonia, whereas OCD conferred greater risk for HEHCs (p < 0.05). Patients with ET had favorable outcomes. Neuropsychiatric comorbidity, Black race, and Charlson Comorbidity Index > 0 were significantly associated with unfavorable outcomes (p < 0.05).
Conclusion: The risk of adverse inpatient outcomes for DBS in the United States is independently correlated with non-PD/ET disorders, neuropsychiatric comorbidity, and non-White race, reflecting the heterogeneity and infancy of widespread DBS for these patients.
Clinical outcomes, Deep brain stimulation, National database, Neuropsychiatric comorbidity, Prevalence, Race
Kortz MW, Kongs BM, McCray E, Grassia F, Hosokawa P, Bernstein JE, Moore SP, Yanovskaya M, Ojemann SG. How Neuropsychiatric Comorbidity, Modulatory Indication, Demographics, and Other Factors Impact Deep Brain Stimulation Inpatient Outcomes in the United States: A Population-Based Study of 27,956 Patients. Clinical Neurology and Neurosurgery. 2021; 208. doi: 10.1016/j.clineuro.2021.106842.