Introduction: As the number of deep brain stimulation (DBS) procedures performed under general anesthesia (“asleep” DBS) increases, it is important to assess the rate of adverse events and inpatient length of stay for these patients compared with those undergoing traditional “awake” DBS without general anesthesia. There have been no previous studies evaluating total complication rates or inpatient lengths of stay for "asleep" DBS surgery.
Methods: All patients undergoing asleep or awake DBS by a single surgeon between August 2011 and August 2014 were reviewed. Adverse events and inpatient length of stay were analyzed for 490 electrodes placed in 284 patients.
Results: 126 patients (63.7%) underwent asleep surgery, and 158 patients (56.6%) underwent awake placement. The most frequent complication was postoperative mental status change (13 patients, 4.6%), followed by hemorrhage (4 patients, 1.4%), seizure (4 patients, 1.4%), and hardware-related infection (3 patients, 1.1%). Mean length of stay for all 284 patients was 1.18 ± 1.22 days (awake: 1.05 ± 0.46 days; asleep: 1.28 ± 1.59 days; p=0.12). There were no significant differences in complications and length of stay between awake vs. asleep cohorts. Within the asleep cohort, a significantly higher proportion of patients with mental status change were greater than or equal to age 65 compared to those without mental status change (p=0.003).
Conclusions: Both awake and asleep DBS can be performed safely with low complication rates. We found no significant differences between the two technique cohorts when comparing adverse events and inpatient lengths of stay.
Patient Care: This research marks the first large patient series evaluating the rate of adverse events and length of hospital stay for patients undergoing "awake" DBS surgery. This will improve patient care by bringing attention to the fact that at a high volume DBS center where both "awake" and "asleep" DBS surgery are performed, the "asleep" procedure can be performed safely with a low rate of adverse events which are not statistically different from traditional asleep surgery. As "asleep DBS" gains popularity and increasing evidence of surgical efficacy is published by our group and others, it is important for clinicians to understand the risk of adverse events when counseling the patients pre-operatively for the procedure. We will also include several learning points regarding complications avoidance techniques in this discussion.
Learning Objectives: By the conclusion of the session, participants should be able to:
1) Describe the main differences in technique between awake and asleep DBS
2) Discuss the factors influencing complications and length of stay variability in awake and asleep DBS
3) Identify and discuss in small groups, complications avoidance techniques for both procedure and hardware-related complications
References: 1. Mirzadeh Z, Chapple K, Lambert M, et al.: Validation of CT-MRI fusion for intraoperative assessment of stereotactic accuracy in DBS surgery. Mov Disord 29:1788-1795, 2014.
2. Chen T, Mirzadeh Z, Chapple K, Lambert M, Dhall R, Ponce FA. Asleep Deep Brain Stimulation for Essential Tremor. Journal of Neurosurgery. 2015 Nov 27:1-8.
3. Fenoy AJ, Simpson RK, Jr.: Risks of common complications in deep brain stimulation surgery: management and avoidance. J Neurosurg 120:132-139, 2014.