How neuropsychiatric comorbidity, modulatory indication, demographics, and other factors impact deep brain stimulation inpatient outcomes in the United States: A population-based study of 27,956 patients

• Published in: Clinical neurology and neurosurgery 2021-09, Vol.208, p.106842-106842, Article 106842
• Main Authors: Kortz, Michael W., Kongs, Brian M., McCray, Edwin, Grassia, Fabio, Hosokawa, Patrick, Bernstein, Jacob E., Moore, Sean P., Yanovskaya, Mariya, Ojemann, Steven G.
• Format: Article
• Language: English
• Subjects: Aged; Brain damage; Brain research; Clinical outcomes; Coma; Comorbidity; Databases, Factual; Deep Brain Stimulation; Delirium; Dementia; Demographics; Demography; Dystonia; Dystonic Disorders - complications; Dystonic Disorders - therapy; Essential Tremor - complications; Essential Tremor - therapy; Female; Hospitals; Humans; Length of stay; Male; Mental disorders; Middle Aged; Movement disorders; National database; Neurodegenerative diseases; Neuropsychiatric comorbidity; Neuroses; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - complications; Obsessive-Compulsive Disorder - therapy; Parkinson Disease - complications; Parkinson Disease - therapy; Parkinson's disease; Patients; Personality disorders; Population studies; Population-based studies; Prevalence; Race; Retrospective Studies; Software; Standard deviation; Treatment Outcome; Tremor; United States
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2021.106842

To determine how neuropsychiatric comorbidity, modulatory indication, demographics, and other characteristics affect inpatient deep brain stimulation (DBS) outcomes. This is a retrospective study of 45 months’ worth of data from the National Inpatient Sample. Patients were aged ≥ 18 years old and underwent DBS for Parkinson Disease (PD), essential tremor (ET), general dystonia and related disorders, other movement disorder (non-PD/ET), or obsessive-compulsive disorder (OCD) at a US hospital. Primary endpoints were prolonged length of stay (PLOS), high-end hospital charges (HEHCs), unfavorable disposition, and inpatient complications. Logistic models were constructed with odds ratios under 95% confidence intervals. A p-value of 0.05 determined significance. Of 214,098 records, there were 27,956 eligible patients. Average age was 63.9 ± 11.2 years, 17,769 (63.6%) were male, and 10,182 (36.4%) patients were female. Most of the cohort was White (51.1%), Medicare payer (64.3%), and treated at a large-bed size (80.7%), private non-profit (76.9%), and metro-teaching (94.0%) hospital. Neuropsychiatric comorbidity prevalence ranged from 29.9% to 47.7% depending on indication. Compared with PD, odds of complications and unfavorable disposition were significantly higher with other movement disorders and dystonia, whereas OCD conferred greater risk for HEHCs (p  0 were significantly associated with unfavorable outcomes (p