美国深部脑刺激治疗运动障碍的安全性和成本趋势：2002-2014 年。

Trends in safety and cost of deep brain stimulation for treatment of movement disorders in the United States: 2002-2014.

机构信息

Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Department of Neurological Surgery, University of California, San Francisco, CA, USA.

出版信息

Br J Neurosurg. 2021 Feb;35(1):57-64. doi: 10.1080/02688697.2020.1759776. Epub 2020 Jun 1.

DOI:10.1080/02688697.2020.1759776

PMID:32476485

Abstract

PURPOSE

Deep brain stimulation (DBS) is being increasingly utilized to treat movement disorders including Parkinson's disease (PD), essential tremor (ET), and dystonia. An improved understanding of national trends in safety and cost is necessary. Herein, our objectives are to (1) characterize complication, mortality, and cost profiles of patients undergoing DBS for movement disorders in the United States, (2) identify predictors of morbidity and mortality, and (3) evaluate impact of complications on cost.

METHODS

DBS surgeries were extracted from the National Inpatient Sample (NIS) 2002-2014 for the clinical indications of PD, ET, and dystonia. Patient characteristics and eight complication categories (hardware malfunction, infection, neurological, other haemorrhagic, thromboembolic, cardiac, pulmonary, and renal/urinary) were reviewed. Outcomes included complications, mortality, hospitalization length, and inflation-adjusted cost.

RESULTS

There were 44,866 weighted admissions (PD-73.5%, ET-22.7%, dystonia-3.8%). The number of procedures increased 2.22-fold from 2002 to 2014 ( = 2372 in 2002; = 5260 in 2014). Inpatient cost was $22,802 ± 13,164, remaining stable from 2002 to 2014 ($24,188 ± 15,910, $20,630 ± 11,031, respectively). Four percent experienced complications (dystonia-6.0%, PD-4.4%, ET-3.1%, < .001). In-hospital mortality was 0.2%. Cost was greater in patients with complications ($36,306 ± 29,263 vs. $22,196 ± 11,560, < .001). Most common complications were renal/urinary (1.5%), neurological (1.1%), and pulmonary (0.7%). Thromboembolic, pulmonary, and haemorrhagic complications were associated with greatest cost.

CONCLUSION

Increased DBS utilization for adult movement disorders in the United States from 2002 to 2014 was attributed to rapid adoption by teaching hospitals for PD. DBS remains a safe procedure with low overall complications and stable inpatient costs from 2002 to 2014. Complication risks vary by type of movement disorder, and although rare, multiple complications increase morbidity and cost of care.

摘要

目的

深部脑刺激（DBS）越来越多地用于治疗运动障碍，包括帕金森病（PD）、特发性震颤（ET）和肌张力障碍。需要更好地了解全国在安全性和成本方面的趋势。在此，我们的目标是：（1）描述美国接受 DBS 治疗运动障碍患者的并发症、死亡率和成本概况；（2）确定发病率和死亡率的预测因素；（3）评估并发症对成本的影响。

方法

从 2002 年至 2014 年的国家住院患者样本（NIS）中提取了用于 PD、ET 和肌张力障碍的 DBS 手术。回顾了患者特征和八个并发症类别（硬件故障、感染、神经、其他出血、血栓栓塞、心脏、肺部和肾脏/泌尿系统）。结果包括并发症、死亡率、住院时间和通胀调整后的成本。

结果

共有 44866 例加权入院（PD-73.5%，ET-22.7%，肌张力障碍-3.8%）。2002 年至 2014 年，手术数量增加了 2.22 倍（2002 年为 2372 例；2014 年为 5260 例）。住院费用为 22802 美元±13164 美元，从 2002 年到 2014 年保持稳定（分别为 24188 美元±15910 美元、20630 美元±11031 美元）。4%的患者出现并发症（肌张力障碍-6.0%，PD-4.4%，ET-3.1%，<0.001）。院内死亡率为 0.2%。有并发症的患者的费用更高（36306 美元±29263 美元与 22196 美元±11560 美元，<0.001）。最常见的并发症是肾脏/泌尿系统（1.5%）、神经（1.1%）和肺部（0.7%）。血栓栓塞、肺部和出血并发症与最高成本相关。