Higuchi Masa-aki, Topiol Dan D, Ahmed Bilal, Morita Hokuto, Carbunaru Samuel, Hess Christopher W, Bowers Dawn, Ward Herbert E, Warren Lisa R, DeFranco Meredith M, Troche Michelle S, Kulkarni Shankar J, Hastings Erin, Foote Kelly D, Okun Michael S, Martinez-Ramirez Daniel
Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America.
Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida, United States of America.
PLoS One. 2015 Dec 28;10(12):e0145623. doi: 10.1371/journal.pone.0145623. eCollection 2015.
To investigate the relationship of our interdisciplinary screening process on post-operative unintended hospitalizations and quality of life.
There are currently no standardized criteria for selection of appropriate Deep Brain Stimulation candidates and little hard data exists to support the use of any singular method.
An Essential Tremor cohort was selected from our institutional Deep Brain Stimulation database. The interdisciplinary model utilized seven specialties who pre-operatively screened all potential Deep Brain Stimulation candidates. Concerns for surgery raised by each specialty were documented and classified as none, minor, or major. Charts were reviewed to identify unintended hospitalizations and quality of life measurements at 1 year post-surgery.
Eighty-six percent (44/51) of the potential screened candidates were approved for Deep Brain Stimulation. Eight (18%) patients had an unintended hospitalization during the follow-up period. Patients with minor or major concerns raised by any specialty service had significantly more unintended hospitalizations when compared to patients without concerns (75% vs. 25%, p < 0.005). The rate of hospitalization revealed a direct relationship to the "level of concern"; ranging from 100% if major concerns, 42% if minor concerns, and 7% if no concerns raised, p = 0.001. Quality of life scores significantly worsened in patients with unintended hospitalizations at 6 (p = 0.046) and 12 months (p = 0.027) when compared to baseline scores. No significant differences in tremor scores between unintended and non-unintended hospitalizations were observed.
The number and level of concerns raised during interdisciplinary Deep Brain Stimulation screenings were significantly related to unintended hospitalizations and to a reduced quality of life. The interdisciplinary evaluation may help to stratify risk for these complications. However, data should be interpreted with caution due to the limitations of our study. Further prospective comparative and larger studies are required to confirm our results.
探讨我们的多学科筛查流程与术后非计划住院及生活质量之间的关系。
目前尚无选择合适的脑深部电刺激术（DBS）候选者的标准化标准，且几乎没有确凿数据支持使用任何单一方法。
从我们机构的脑深部电刺激术数据库中选取了一组特发性震颤患者。多学科模式利用七个专业科室在术前对所有潜在的脑深部电刺激术候选者进行筛查。记录每个专业科室提出的手术相关问题，并将其分类为无、轻微或严重。查阅病历以确定术后1年的非计划住院情况及生活质量测量结果。
86%（44/51）的潜在筛查候选者被批准进行脑深部电刺激术。8名（18%）患者在随访期间出现非计划住院。与无问题的患者相比，任何专业科室提出轻微或严重问题的患者出现非计划住院的情况明显更多（75%对25%，p<0.005）。住院率与“关注程度”呈直接关系；严重问题患者为100%，轻微问题患者为42%，无问题患者为7%，p = 0.001。与基线评分相比，出现非计划住院的患者在6个月（p = 0.046）和12个月（p = 0.027）时生活质量评分显著恶化。在非计划住院和非非计划住院患者之间未观察到震颤评分有显著差异。
多学科脑深部电刺激术筛查期间提出的问题数量和关注程度与非计划住院及生活质量下降显著相关。多学科评估可能有助于对这些并发症的风险进行分层。然而，由于我们研究的局限性，数据应谨慎解读。需要进一步的前瞻性比较研究和更大规模的研究来证实我们的结果。
