Abstract
BackgroundAs a complication-prone operation, deep brain stimulation (DBS) has become the first-line surgical approach for patients with advanced Parkinson’s disease (PD). This study aimed to evaluate the incidence and risk factors of DBS-associated complications.MethodsWe have reviewed a consecutive series of patients with PD undergoing DBS procedures to describe the type, severity, management, and outcome of postoperative complications from January 2011 to December 2018. Both univariate and multivariate analyses were performed to identify statistically significant risk factors. We also described our surgical strategies to minimize the adverse events.ResultsA total of 225 patients underwent 229 DBS implantation procedures (440 electrodes), of whom 20 patients experienced 23 DBS-associated complications, including ten operation-related complications and 13 hardware-related ones. Univariate analysis elucidated that comorbid medical conditions (P = 0.024), hypertension (P = 0.003), early-stage operation (P < 0.001), and unilateral electrode implantation (P = 0.029) as risk factors for overall complications, or more specifically, operation-related complications demonstrated in the stratified analysis. In contrast, no risk factor for hardware-related complications was identified. Statistical significances of hypertension (OR = 3.33, 95% CI: 1.14–9.71, P = 0.027) and early-stage (OR = 11.04, 95% CI: 2.42–50.45, P = 0.002) were further validated via multivariate analysis. As the annual number of DBS procedures increased, the incidence of complications gradually decreased (R = −0.699, P < 0.01). Additionally, there was a strong correlation between surgical complications and unplanned readmission (R = 0.730, P < 0.01).ConclusionThe importance of cumulative experience and relevant technique modifications should be addressed to prevent DBS-associated complications and unplanned readmission.
Highlights
IntroductionDeep brain stimulation (DBS) is the therapeutic approach of intracranial electrical stimulation, which uses a four-contact stimulating electrode stereotactically implanted in the target and connected via a subcutaneous wire to an implantable pulse generator (IPG) that is placed on the chest wall underneath the collarbone
Univariate analysis elucidated that comorbid medical conditions (P = 0.024), hypertension (P = 0.003), early-stage operation (P < 0.001), and unilateral electrode implantation (P = 0.029) as risk factors for overall complications, or operationrelated complications demonstrated in the stratified analysis
Deep brain stimulation (DBS) is the therapeutic approach of intracranial electrical stimulation, which uses a four-contact stimulating electrode stereotactically implanted in the target and connected via a subcutaneous wire to an implantable pulse generator (IPG) that is placed on the chest wall underneath the collarbone
Summary
Deep brain stimulation (DBS) is the therapeutic approach of intracranial electrical stimulation, which uses a four-contact stimulating electrode stereotactically implanted in the target and connected via a subcutaneous wire to an implantable pulse generator (IPG) that is placed on the chest wall underneath the collarbone. Most targets of DBS are deep brain structures, including deep nucleus and white matter tracts (Herrington et al, 2016). Effective, reversible, and controllable approach, DBS has gradually replaced conventional destructive surgery and has become the most common surgical option for advanced Parkinson’s disease (PD)(Okun, 2012; RamirezZamora and Ostrem, 2018). As a complication-prone operation, deep brain stimulation (DBS) has become the first-line surgical approach for patients with advanced Parkinson’s disease (PD). This study aimed to evaluate the incidence and risk factors of DBSassociated complications
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