Introduction: Deep Brain Stimulation (DBS) is a well-established modality for the treatment of advanced Parkinson’s Disease (PD), but some centers exclude older patients. In this study, we evaluated the impact of increasing age on complications associated with DBS surgery.
Methods: A retrospective, cohort study was performed using the Thomson Reuters MarketScan® database, examining patients who underwent DBS for PD from 2000-2009. Primary outcomes included aggregate and individual complications within 30 and 90 days following surgery. Multivariate logistic regression analysis was used to calculate complication odds ratios for age after controlling for patient demographics and comorbidity scores.
Results: The study cohort was 1,688 patients. The 90-day cumulative incidence of complications was 7.6%, with a mortality rate of 0.4%. Advancing age was associated with increasing frequency of complications (65-69 years, 5.4%; 70-74 years, 11.7%; 75-79 years, 5.32%; 80-84 years, 19.0%) and mortality (65-69 years, 0.4 %; 70-74 years, 0.4 %; 75-79 years, 2.13%). Overall, 128 (7.6%) patients experienced at least one complication within 90 days, including wound infections (3.4%), pneumonia (2.6%), hemorrhage or hematoma (1.7%), or pulmonary embolism (0.5%). After adjusting for covariates, increasing age was associated with a significantly higher 90-day complication rate (OR 1.18 per 5-year increase; 95% CI 1.02, 1.36; P = 0.026), which was largely attributable to increased pneumonia rates (OR 1.44 per 5-year increase; 95% CI 1.11, 1.88; P = 0.007). The two most common early complications, hemorrhage and infection, had no detectable increase with age (hemorrhage OR 0.86; 95% CI 0.66, 1.11; P = 0.248, infection OR 1.17; 95% CI 0.95, 1.45; P = 0.141).
Conclusions: Among older PD patients, the risk of postoperative hemorrhage or infection remains relatively stable despite increasing age. The risk of developing postoperative pneumonia does significantly increase with age. These age-related risks should be considered when counseling older patients regarding DBS surgery.
Patient Care: Our research will help clinicians better weigh the benefits and risks of deep brain stimulation surgery for older patients with Parkinson's disease.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the impact of age on the risk of complication following deep brain stimulation surgery for Parkinson's disease, and 2) Better counsel patients on the risks of deep brain stimulation surgery for older patients.