Departments of Neurological Surgery and.
J Neurosurg. 2013 Dec;119(6):1546-55. doi: 10.3171/2013.8.JNS13475. Epub 2013 Sep 27.
Early work on deep brain stimulation (DBS) surgery, when procedures were mostly carried out in a small number of high-volume centers, demonstrated a relationship between surgical volume and procedural safety. However, over the past decade, DBS has become more widely available in the community rather than solely at academic medical centers. The authors examined the Nationwide Inpatient Sample (NIS) to study the safety of DBS surgery for Parkinson disease (PD) in association with this change in practice patterns.
The NIS is a stratified sample of 20% of all patient discharges from nonfederal hospitals in the United States. The authors identified patients with a primary diagnosis of PD (332.0) and a primary procedure code for implantation/replacement of intracranial neurostimulator leads (02.93) who underwent surgery between 2002 and 2009. They analyzed outcomes using univariate and hierarchical, logistic regression analyses.
The total number of DBS cases remained stable from 2002 through 2009. Despite older and sicker patients undergoing DBS, procedural safety (rates of non-home discharges, complications) remained stable. Patients at low-volume hospitals were virtually indistinguishable from those at high-volume hospitals, except that patients at low-volume hospitals had slightly higher comorbidity scores (0.90 vs 0.75, p < 0.01). Complications, non-home discharges, length of hospital stay, and mortality rates did not significantly differ between low- and high-volume hospitals when accounting for hospital-related variables (caseload, teaching status, location).
Prior investigations have demonstrated a robust volume-outcome relationship for a variety of surgical procedures. However, the present study supports safety of DBS at smaller-volume centers. Prospective studies are required to determine whether low-volume centers and higher-volume centers have similar DBS efficacy, a critical factor in determining whether DBS is comparable between centers.
早期的深部脑刺激 (DBS) 手术研究主要在少数高容量中心进行，这些研究表明手术量与程序安全性之间存在关系。然而，在过去十年中，DBS 在社区中的应用变得更加广泛，而不仅仅是在学术医疗中心。作者通过研究全国住院患者样本 (NIS)，研究与这种实践模式变化相关的 DBS 手术治疗帕金森病 (PD) 的安全性。
NIS 是美国非联邦医院所有患者出院的 20%的分层样本。作者确定了 2002 年至 2009 年间患有原发性 PD（332.0）诊断和颅内神经刺激器导联植入/更换主要手术代码（02.93）的患者。他们使用单变量和分层逻辑回归分析来分析结果。
2002 年至 2009 年，DBS 病例总数保持稳定。尽管接受 DBS 的患者年龄更大、病情更重，但程序安全性（非家庭出院率、并发症率）保持稳定。低容量医院的患者与高容量医院的患者几乎没有区别，只是低容量医院的患者合并症评分略高（0.90 对 0.75，p < 0.01）。当考虑与医院相关的变量（病例量、教学状态、位置）时，低容量和高容量医院之间的并发症、非家庭出院率、住院时间和死亡率没有显著差异。
先前的研究表明，各种手术的手术量与结果之间存在强有力的关系。然而，本研究支持在较小容量中心进行 DBS 的安全性。需要前瞻性研究来确定低容量中心和高容量中心是否具有相似的 DBS 疗效，这是确定中心之间 DBS 是否可比的关键因素。
