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  • An Unexpectedly High Rate of Revisions for Deep Brain Stimulation Surgery in North America

    Final Number:

    John David Rolston MD PhD; Dario J. Englot MD PhD; Philip A. Starr MD, PhD; Paul S. Larson

    Study Design:

    Subject Category:
    Movement Disorders

    Meeting: 2016 ASSFN Biennial Meeting

    Introduction: While many studies describe outcomes and complications related to deep brain stimulation (DBS), the majority of these are from large academic centers, and results may differ from those in general neurosurgical practice.

    Methods: Using data from the Centers for Medicare and Medicaid Services and the American College of Surgeons (ACS), we identified all DBS procedures related to primary placement, revision, or removal of intracranial electrodes.

    Results: Over 28,000 cases of DBS electrode placement, revision, and removal were identified during the years 2004-2013. Between 15.2% and 34.0% of these procedures were for electrode revision or removal. Significant predictors of revision and removal were decreased age (odds ratio (OR) of 0.96; 95% CI: 0.94, 0.98) and higher ASA classification (OR 2.41; 95% CI: 1.22, 4.75). Up to 48.5% of revisions may have been due to improper targeting or lack of therapeutic effect.

    Conclusions: Data from the multiple databases suggest that DBS has a higher rate of revision and removal than previously reported. There is a clear need to better track and understand the true prevalence and nature of such failures as they occur in the wider surgical community.

    Patient Care: Understanding the frequency and predictors of DBS revision surgery will help direct future research into preventing the need for revision surgery.

    Learning Objectives: By conclusion of this session, participants should be able to: 1) Describe the frequency of revision surgery for deep brain stimulation (DBS); 2) Describe common complications of DBS surgery; 3) Identify areas where additional research will help understand the frequency and causes of revision surgery for DBS.


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