Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA.
Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA; Neurosurgery Division, Surgery Department, Jazan University, Jazan, Kingdom of Saudi Arabia.
World Neurosurg. 2020 Dec;144:e347-e352. doi: 10.1016/j.wneu.2020.08.140. Epub 2020 Aug 24.
Advancing age and greater number of medical comorbidities are well-known risk factors for higher rates of surgical complications and undesirable outcomes. We sought to determine the risk of increasing medical comorbidities on surgical outcomes for patients with Parkinson disease undergoing deep brain stimulation (DBS) surgery.
We retrospectively reviewed 107 consecutive patients who underwent DBS for Parkinson disease at Ochsner Medical Center in 2008-2018. Patients were stratified into 3 groups based on Elixhauser comorbidity index (ECI) at the time of surgery: 0, 1, or ≥2. Outcome measures were changes in Unified Parkinson's Disease Rating Scale III scores, changes in medications, and surgical complications. Analysis of variance, paired t test, and nonparametric equivalents were used for statistical analysis.
Of patients, 31 (29.0%) had ECI score 0, 44 (41.1%) had ECI score 1, and 32 (29.9%) had ECI score ≥2. For all groups, Unified Parkinson's Disease Rating Scale III scores decreased significantly postoperatively (P = 0.0014, P < 0.0001, P < 0.0001). All groups had a reduction in mean levodopa equivalent daily dose after surgery; however, only the group with ≥2 comorbidities achieved statistical significance (P = 0.0026). The rate of postoperative complications was significantly correlated with comorbidity score on univariate logistic regression analysis (P = 0.0425).
Our findings indicate that DBS is efficacious in patients with multiple medical comorbidities. However, patients with ≥1 medical comorbidities may be more likely to have complications. The most common observed complication was wound infection. Patients with medical comorbidities may still benefit significantly from DBS when performed at experienced centers.
年龄增长和更多的合并症是手术并发症和不良结局发生率较高的已知危险因素。我们旨在确定帕金森病患者接受深部脑刺激（DBS）手术时合并症数量增加对手术结果的影响。
我们回顾性分析了 2008 年至 2018 年在奥克斯纳医疗中心接受 DBS 治疗的 107 例连续帕金森病患者。根据手术时的 Elixhauser 合并症指数（ECI），患者分为 3 组：0、1 或≥2。结果测量包括统一帕金森病评定量表 III 评分的变化、药物变化和手术并发症。采用方差分析、配对 t 检验和非参数等效方法进行统计学分析。
31 例（29.0%）患者的 ECI 评分为 0，44 例（41.1%）为 1，32 例（29.9%）为≥2。所有组术后统一帕金森病评定量表 III 评分均显著降低（P=0.0014，P<0.0001，P<0.0001）。所有组术后左旋多巴等效日剂量均降低，但仅 ECI≥2 的组有统计学意义（P=0.0026）。术后并发症发生率与单因素逻辑回归分析中的合并症评分显著相关（P=0.0425）。
我们的发现表明，DBS 对患有多种合并症的患者有效。然而，患有≥1 种合并症的患者更有可能出现并发症。最常见的观察到的并发症是伤口感染。在经验丰富的中心进行 DBS 治疗时，患有合并症的患者仍可显著获益。
