Introduction: Essential tremor (ET) was the original indication for Deep Brain Stimulation (DBS), with FDA-approval since 1997. Given that the prevalence of ET increases nearly 10-fold with age, we evaluated the step-wise impact of increasing age on short-term complications following DBS surgery. We hypothesized that increasing age would be associated with an increase in postoperative complications.
Methods: A large, retrospective, cohort study was performed using the Thomson Reuters MarketScan® national database, examining patients who underwent DBS for ET from 2000-2009. Hospital length of stay, aggregate and individual complications within 90-days following surgery were evaluated. Multivariate logistic regression analysis was used to calculate complication odds ratios for each 5-year age epoch after controlling for covariates.
Results: A total of 661 patients were included in the analysis. The mean+/-SD patient age was 61.9+/-14.3years, with 17% of individuals age 75 or older. Overall, 56.9% of patients were male, and 44.6% had a Charlson Comorbidity Score of one or greater, Table 1. A total of 7.1% of patients experienced at least one complication within 90-days, including wound infections (3.0%), pneumonia (2.4%), hemorrhage/hematoma (1.5%), or pulmonary embolism (0.6%), Table 2. After adjusting for covariates, increasing age ranging from <50 to 90 years, did not significantly impact overall 90-day complication rates (OR 0.89 per 5-year increase; 95%CI 0.77, 1.02; p=0.102), Table 3. The two most common procedure-related complications, hemorrhage and infection, did not significantly increase with age (hemorrhage: OR 1.02; 95%CI 0.77, 1.37; p=0.873, infection: OR 0.88; 95%CI 0.72, 1.07; p=0.203).
Conclusions: Among older ET patients, 90-day complication risk and the risk of postoperative hemorrhage or infection remained relatively stable, despite increasing age. Our findings suggest that age should not be a primary exclusion factor for determining candidacy for DBS and possible expansion of the traditional therapeutic window.
Patient Care: Our findings suggest that age should not be a primary exclusion factor for determining candidacy for DBS and possible expansion of the traditional therapeutic window.
Learning Objectives: Our findings suggest that age should not be a primary exclusion factor for determining candidacy for DBS and possible expansion of the traditional therapeutic window.