Predictors of unfavorable outcomes following deep brain stimulation for movement disorders and the effect of hospital case volume on outcomes: an analysis of 33, 642 patients across 234 US hospitals using the National (Nationwide) Inpatient Sample from 2002 to 2011

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>With limited data available on association of risk factors and effect of hospital case volume on outcomes following deep brain stimulation (DBS), the authors attempted to identify these associations using a large population-based database.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors performed a retrospective cohort study involving patients who underwent DBS for 3 primary movement disorders: Parkinson’s disease, essential tremor, and dystonia from 2002 to 2011 using the National (Nationwide) Inpatient Sample (NIS) database. Using national estimates, the authors identified associations of patient demographics, clinical characteristics, and hospital characteristics on short-term postoperative outcomes following DBS. Additionally, effect of hospital volume on unfavorable outcomes was investigated.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Overall, 33, 642 patients underwent DBS for 3 primary movement disorders across 234 hospitals in the US. The mean age of the cohort was 63.42 ± 11.31 years and 36% of patients were female. The inpatients’ postoperative risks were 5.9% for unfavorable discharge, 10.2% for prolonged length of stay, 14.6% for high-end hospital charges, 0.5% for wound complications, 0.4% for cardiac complications, 1.8% for venous thromboembolism, and 5.5% for neurological complications, including those arising from an implanted nervous system device. Compared with low-volume centers, odds of having an unfavorable discharge, prolonged LOS, high-end hospital charges, wound, and cardiac complications were significantly lower in the high-volume and medium-volume centers.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The authors’ study provides individualized estimates of the risks of postoperative complications based on patient demographics and comorbidities and hospital characteristics, which could potentially be used as an adjunct for risk stratification for patients undergoing DBS.</jats:p></jats:sec>

An unexpectedly high rate of revisions and removals in deep brain stimulation surgery: Analysis of multiple databases

“…Prior studies using the Nationwide Inpatient Sample found a beneficial association between surgical volume and outcome [14,26], so it is possible that by including many low-volume surgical centers in the above analysis, we observe an increased rate of revisions and removals that high-volume centers do not encounter—and these are the centers that typically publish their surgical experiences. Such volume-outcome relationships have been observed in nearly all areas of neurosurgery [27], and could be explored as a possible contributor to DBS revisions.…”

“…This is a very useful dataset, since Medicare covers an estimated 63% of DBS surgery implants [14]. Also of note, the American College of Surgeons (ACS) began prospectively collecting data on surgical procedures and their complications in 2005 as part of the National Surgical Quality Improvement Program (NSQIP) [15–17].…”

“…Medical and surgical complications are strictly defined, unlike many retrospective studies, and the data entry personnel are frequently audited to ensure accurate additions to the database. Unlike the commonly studied Nationwide Inpatient Sample (NIS) [14,18], NSQIP does not rely on billing statistics for its data acquisition, and is based on the more specific Current Procedure Terminology (CPT) codes to identify surgical procedures, rather than the International Classification of Diseases (ICD-9) codes. As an example, ICD-9 has one code for primary placement or revision of DBS leads (02.93), but there is no way to determine whether a procedure is a primary placement or revision from ICD-9.…”

Adolescent idiopathic scoliosis: risk factors for complications and the effect of hospital volume on outcomes

“…Previous studies have explored the volume-outcome relationship in the context of several neurosurgical procedures, [2][3][4][5][6]15,16,23,24,26,28,29,44,51,54 including those involving the spine. 17,20,28,42,43 For scoliosis surgery, Patil et al 41 defined 5 hospital surgical volume cutoffs ranging from < 21 operations per year to > 147 per year.…”

Ablative surgery for Parkinson’s disease: Is there still a role for pallidotomy in the deep brain stimulation era?

“…The studies about this subject, however, have not proven so far that diabetes is an isolated risk factor for device infection [51][52][53][68][69][70]. No large prospective study concerning that has been done so far.…”