Acute readmission following deep brain stimulation surgery for Parkinson's disease: A nationwide analysis.

Introduction: Deep brain stimulation (DBS) surgery is an efficacious, underutilized treatment for Parkinson's disease (PD). Studies of DBS post-operative outcomes are often restricted to data from a single center and consider DBS in isolation. National estimates of DBS readmission and post-operative outcomes are needed, as are comparisons to commonly performed surgeries.
Methods: This study used datasets from the 2013 and 2014 Nationwide Readmissions Database (NRD). Our sample was restricted to PD patients discharged alive after hospitalization for DBS surgery. Descriptive analyses examined patient, clinical, hospital and index hospitalization characteristics. The all-cause, non-elective 30-day readmission rate after DBS was calculated, and logistic regression models were built to examine factors associated with readmission. Readmission rates for the most common surgical procedures were calculated and compared to DBS.
Results: There were 6058 DBS surgeries for PD in our sample, most often involving a male aged 65 and older, who lived in a high socioeconomic status zip code. DBS patients had an average of four comorbidities. With respect to outcomes, the majority of patients were discharged home (95.3%). Non-elective readmission was rare (4.9%), and was associated with socioeconomic status, comorbidity burden, and teaching hospital status. Much higher acute, non-elective readmission rates were observed for common procedures such as upper gastrointestinal endoscopy (16.2%), colonoscopy (14.0%), and cardiac defibrillator and pacemaker procedures (11.1%).
Conclusion: Short-term hospitalization outcomes after DBS are generally favorable. Socioeconomic disparities in DBS use persist. Additional efforts may be needed to improve provider referrals for and patient access to DBS.
Competing Interests: Declaration of competing interest RBS: Has no conflicts of interest relevant to this work but reports grant support from the National Institute of Neurological Disorders and Stroke, Biohaven Pharmaceuticals, CHDI Foundation, Teva Pharmaceuticals, Pfizer, Nuredis Inc., The Michael J. Fox Foundation, and the Canadian Institute of Health Research as well as financial support from the Parkinson's Foundation. JJ-S: Reports research support from Medtronic and St. Jude Medical/Abbott as well as consulting agreements with Medtronic, St. Jude Medical/Abbott, and Boston Scientific relevant to this work. Also reports research support from Teva and Lilly; consulting agreements with Bracket and Nuvelution; and grant support from the National Institute of Neurological Disorders and Stroke, the Michael J. Fox Foundation, and the Simons Foundation. DSA: Has no conflicts of interest relevant to this work but reports research support from the National Institutes of Health and financial support from the Parkinson's Foundation. DPT: None. SM: None. MF: Has no conflicts of interest relevant to this work but reports active research funding from the American Academy of Neurology, American Brain Foundation, and the Parkinson's Foundation. MAB: Has no conflicts of interest relevant to this work but reports active research funding from the Parkinson's Foundation. KLC: Has no conflicts of interest relevant to this work but reports active research funds from the National Institutes of Health and the Parkinson Study Group, consulting agreements with Sunovion Pharmaceuticals, and royalties from UpToDate and Springer. MS: Has no conflicts of interest relevant to this work but reports active research funding from Abbvie, USWorldMeds, Sanofi, Lundbeck, and Abbott. WJJ: None. P-FD: Has no conflicts of interest relevant to this work but reports service as an Officer of Neurotargeting LLC. MKY: Has no conflicts of interest relevant to this work but reports personal compensation for consultant, Steering Committee, and Data Safety Monitoring Board service from the Michael J. Fox Foundation and Boston Scientific. JCK: None. JMS: Has no conflicts of interest relevant to this work but reports research grants from Medtronic, service as a consultant for Guidant, LLC, and salary support from Blue Cross Blue Shield of Michigan. AJE: Has no conflicts of interest relevant to this work but reports grant support from the National Institutes of Health, Great Lakes Neurotechnologies, and the Michael J Fox Foundation; personal compensation as a consultant/scientific advisory board member for Abbvie, Neuroderm, TEVA, Impax, Acadia, Acorda, Cynapsus/Sunovion, Lundbeck, Osmotica Pharmaceutical, and USWorldMeds; publishing royalties from Lippincott Williams & Wilkins, Cambridge University Press, and Springer; and honoraria from Abbvie, UCB, USWorldMeds, Lundbeck, Acadia, the American Academy of Neurology, and the Movement Disorders Society. LCS: Has no conflicts of interest relevant to this work but reports employment with Biogen, Inc. DKS: Has no conflicts of interest relevant to this work but reports research funding from BioElectron Technology, Lysosomal Therapeutics, Mission Therapeutics, Voyager Therapeutics, the Weston Brain Institute, and the National Institutes of Health as well as honorarium for Steering Committee service from the Michael J. Fox Foundation and Biogen. CH: None. JAGC: Has no conflicts of interest relevant to this work but reports research support from the Northern Ontario Academic Medicine Association. AWW: Has no conflicts of interest relevant to this work but reports research funding from the National Institutes of Health and the Parkinson's Foundation.
(Copyright © 2019. Published by Elsevier Ltd.)