Introduction: Deep brain stimulation (DBS) surgery is being increasingly utilized for the treatment movement disorders including Parkinson’s disease (PD), essential tremor (ET), and isolated dystonia. With this rising trend in DBS surgery performed, quantitative assessment of complications and costs-of-care following DBS surgery are necessary and remain understudied.

Methods: Adult DBS admissions were extracted from the National Inpatient Sample (NIS) years 2002-2014 for the major clinical indications of PD, ET, and dystonia. Patient and hospital characteristics, and ten categories of inpatient complications(hardware malfunction, infection, lead removal, stroke/neurologic, hemorrhage/seroma, thromboembolism, cardiac, pulmonary, urinary, renal) were extracted. Outcomes were complications, hospital length of stay (HLOS), and cost. Multivariable regression was performed. Cost was measured using inflation-adjusted healthcare cost [charge*(cost/charge ratio)]. Mean differences (B), odds ratios (OR) and 95% confidence intervals [95% CI] are reported. Statistical significance was assessed at p<0.001.

Results: In a sample of 44866 admissions (73.5% PD, 22.7% ET, 3.8% dystonia) from 2002-2014, average age was 63.9±11.0 years and 64.1% were male. The number of DBS procedures increased by 222%. This is largely driven by an increase in procedures performed at teaching institutions and for PD patients. HLOS was 1.9±2.5 days and 4.3% of admissions experienced =1 complications (ET-3.2%, PD-4.5%, dystonia-6.0%). In-hospital mortality was 0.2%. Mean cost for each admission was $22802±13164, higher in patients experiencing complications ($36306±697 vs. $22196±58, p<0.001). Most frequent complications were urinary (1.5%), stroke/neurologic (1.1%), and pulmonary (0.7%). Increased costs due to complications ranged from $4277(hardware malfunction) to $25907(hemorrhage/seroma). ET had shorter HLOS, less complications and lower costs, while dystonia had higher costs.

Conclusions: The number of annual DBS procedures continues to increase, growing more rapidly at teaching institutions and for PD patients. Outcomes vary with clinical diagnosis, disease severity, mortality risk, and demographics/geography. While DBS surgery is safe, improved strategies of perioperative care can expedite recovery and decrease healthcare expenditures.

Patient Care: Overall costs and complications of DBS surgery need to be updated given the growing interest in the United States (U.S.). While prior studies have reported hospital charges associated with DBS,[1,2,3,4] hospital charges more so reflect administrative billing and overestimate true costs by a large margin.2,14 A detailed characterization of cost trends, complications and associated costs-of-care are lacking in the literature. Given the recent changes in U.S. healthcare delivery and the need for evidence-based surgery, this study is indicated on a national level to quantify patient risks, define surgical management plans, and reduce overall expenditures.

Learning Objectives: By the conclusion of the session, participants should be able to: 1) Describe the growth in DBS surgery and cost trends for the treatment of refractory movement disorders in the United States in the decade following FDA approval. 2) Determine the patient risks associated with DBS surgery, along with quantifying the costs associated with common adverse events. 3) Discuss the risk factors associated with DBS surgery for advanced movement disorders, and strategies to minimize perioperative events in order to further improve outcomes and reduce overall cost burden.

References: 1. Eskandar EN, Flaherty A, Cosgrove GR, Shinobu LA, Barker FG 2nd: Surgery for Parkinson disease in the United States, 1996 to 2000: practice patterns, short-term outcomes, and hospital charges in a nationwide sample. J Neurosurg 99:863–871, 2003 2. Lad SP, Kalanithi PS, Patil CG, Itthimathin P, Batya S, Bronte-Stewart H, et al: Socioeconomic Trends in Deep Brain Stimulation (DBS) Surgery. Neuromodulation: Technology at the Neural Interface 13:182–186, 2010 3. Sharma M, Ambekar S, Guthikonda B, Wilden J, Nanda A: Regional trends and the impact of various patient and hospital factors on outcomes and costs of hospitalization between academic and nonacademic centers after deep brain stimulation surgery for Parkinson’s disease: a United States Nationwide Inpatient Sample analysis from 2006 to 2010. Neurosurg Focus 35:E2, 2013 4. Youngerman BE, Chan AK, Mikell CB, McKhann GM, Sheth SA: A decade of emerging indications: deep brain stimulation in the United States. J Neurosurg 125:461–471, 2016