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  • Staged versus Simultaneous Bilateral Deep Brain Stimulation Surgery for Parkinson’s Disease: Impact on Health Outcomes.

    Final Number:
    467

    Authors:
    Terence Verla; Ulysses Toche; Owoicho Adogwa M.D. M.P.H; John Gallis; Yuliya Lokhnygina; Shivanand P. Lad MD PhD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Deep Brain Stimulation (DBS) has been shown to be effective in treating medically refractory Parkinson’s Disease (PD), with long-term improvement in quality of life. Bilateral DBS can be performed simultaneously or staged based on symptom severity. The goal of this study was to evaluate the impact of staging on health outcomes following DBS for PD.

    Methods: A large, retrospective cohort study was performed using the Thomson Reuter’s MarketScan® national database, examining patient who underwent bilateral DBS between 2000 and 2009. Patients were separated into cohorts based on simultaneous-bilateral or staged-bilateral DBS. Multivariate regression analysis was used to evaluate complications, lead revision, generator reprogramming and annual healthcare cost.

    Results: A total of 653 patients were included in the analysis (Simultaneous: 531(81.3%) vs. Staged: 122(18.7%)). The mean±SD age was 61.4±9.6years (Simultaneous: 60.9±9.6years vs. Staged: 63.6±9.5years). Overall, 30.6% of patients were female (Simultaneous: 31.5% vs. Staged: 27.1%) and 39.2% had a Charlson score of =1 (Simultaneous: 39.6% vs. Staged: 37.7%), Table 1. After adjusting for age, gender, Charlson index, insurance, employment status and year of procedure, staged-bilateral DBS was associated with increased odds of device-related complications (OR 1.99; 95% CI 1.21, 3.26; p=0.006), increased postoperative reprogramming time (RR 1.15; 95% CI 1.06, 1.25; p<0.001) and lower hazard of lead revision (HR 0.51; 95% CI 0.31, 0.83; p=0.007), Tables 2&3. There was no significant difference in annual healthcare cost between both cohorts.

    Conclusions: In this retrospective analysis, staged-bilateral DBS was associated with increased device-related complications but decreased incidence of lead revision, compared to simultaneous-bilateral DBS. These results may be valuable to physicians and patients in the decision algorithm when planning bilateral DBS for PD.

    Patient Care: Staged-bilateral DBS was associated with increased device-related complications but decreased incidence of lead revision, compared to simultaneous-bilateral DBS. These results may be valuable to physicians and patients in the decision algorithm when planning bilateral DBS for PD.

    Learning Objectives: Staged-bilateral DBS was associated with increased device-related complications but decreased incidence of lead revision, compared to simultaneous-bilateral DBS

    References:

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