Ramayya Ashwin G, Abdullah Kalil G, Mallela Arka N, Pierce John T, Thawani Jayesh, Petrov Dmitry, Baltuch Gordon H
Department of Neurosurgery, Perelman School of Medicine, University of Penn-sylvania, Philadelphia, Pennsylvania.
Neurosurgery. 2017 Aug 1;81(2):259-267. doi: 10.1093/neuros/nyx019.
Deep brain stimulation (DBS) has emerged as a safe and efficacious surgical intervention for several movement disorders; however, the 30-day all-cause readmission rate associated with this procedure has not previously been documented.
To perform a retrospective cohort study to estimate the 30-day all-cause readmission rate associated with DBS.
We reviewed medical records of patients over the age of 18 who underwent DBS surgery at Pennsylvania Hospital of the University of Pennsylvania between 2009 and 2014. We identified patients who were readmitted to an inpatient medical facility within 30 days from their initial discharge.
Over the study period, 23 (6.6%) of 347 DBS procedures resulted in a readmission to the hospital within 30 days. Causes of readmission were broadly categorized into surgery-related (3.7%): intracranial lead infection (0.6%), battery-site infection (0.6%), intracranial hematoma along the electrode tract (0.6%), battery-site hematoma (0.9%), and seizures (1.2%); and nonsurgery-related (2.9%): altered mental status (1.8%), nonsurgical-site infections (0.6%), malnutrition and poor wound healing (0.3%), and a pulse generator malfunction requiring reprogramming (0.3%). Readmissions could be predicted by the presence of medical comorbidities ( P < .001), but not by age, gender, or length of stay ( P s > .15).
All-cause 30-day readmission for DBS is 6.6%. This compares favorably to previously studied neurosurgical procedures. Readmissions frequently resulted from surgery-related complications, particularly infection, seizures, and hematomas, and were significantly associated with the presence of medical comorbidities ( P < .001).
对于多种运动障碍,脑深部电刺激术(DBS)已成为一种安全有效的外科干预手段;然而,此前尚未记录该手术相关的30天全因再入院率。
进行一项回顾性队列研究,以评估与DBS相关的30天全因再入院率。
我们回顾了2009年至2014年间在宾夕法尼亚大学宾夕法尼亚医院接受DBS手术的18岁以上患者的病历。我们确定了那些在首次出院后30天内再次入住住院医疗机构的患者。
在研究期间,347例DBS手术中有23例(6.6%)在30天内再次入院。再入院原因大致分为与手术相关的(3.7%):颅内电极感染(0.6%)、电池部位感染(0.6%)、沿电极轨迹的颅内血肿(0.6%)、电池部位血肿(0.9%)和癫痫发作(1.2%);以及与非手术相关的(2.9%):精神状态改变(1.8%)、非手术部位感染(0.6%)、营养不良和伤口愈合不良(0.3%),以及需要重新编程的脉冲发生器故障(0.3%)。再入院情况可通过合并症的存在来预测(P <.001),但不能通过年龄、性别或住院时间来预测(P值>.15)。
DBS的30天全因再入院率为6.6%。这与之前研究的神经外科手术相比具有优势。再入院频繁是由与手术相关的并发症引起的,特别是感染、癫痫发作和血肿,并且与合并症的存在显著相关(P <.001)。