Clinical Edge

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High Rate of Revisions, Removals in DBS Surgery

Parkinsonism Relat Disord; ePub 2016 Sep 12; Rolston, et al

Data from multiple North American databases suggest that intracranial neurostimulation therapies have a rate of revision and removal higher than previously reported, between 15.2 and 34.0%, according to a recent study. Using data from both the Centers for Medicare and Medicaid Services (CMS) and the National Surgical Quality Improvement Program (NSQIP), researchers identified all deep brain stimulation (DBS) procedures related to primary placement, revision, or removal of intracranial electrodes. More than 28,000 cases were identified during the years 2004 to 2013. They found:

  • In the Medicare dataset, 15.2% and of these procedures were for intracranial electrode revision or removal, compared to 34.0% in the NSQIP dataset.
  • In NSQIP, significant predictors of revision and removal were decreased age odds ratio (OR) of 0.96; and higher ASA classification (OR 2.41).
  • Up to 48.5% of revisions may have been due to improper targeting or lack of therapeutic effect.

Citation:

Rolston JD, Englot DJ, Starr PA, Larson PS. An unexpectedly high rate of revisions and removals in deep brain stimulation surgery: Analysis of multiple databases. [Published online ahead of print September 12, 2016]. Parkinsonism Relat Disord. doi:10.1016/j.parkreldis.2016.09.014.

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