Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA.
College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA.
Clin Neurol Neurosurg. 2021 Sep;208:106842. doi: 10.1016/j.clineuro.2021.106842. Epub 2021 Jul 26.
To determine how neuropsychiatric comorbidity, modulatory indication, demographics, and other characteristics affect inpatient deep brain stimulation (DBS) outcomes.
This is a retrospective study of 45 months' worth of data from the National Inpatient Sample. Patients were aged ≥ 18 years old and underwent DBS for Parkinson Disease (PD), essential tremor (ET), general dystonia and related disorders, other movement disorder (non-PD/ET), or obsessive-compulsive disorder (OCD) at a US hospital. Primary endpoints were prolonged length of stay (PLOS), high-end hospital charges (HEHCs), unfavorable disposition, and inpatient complications. Logistic models were constructed with odds ratios under 95% confidence intervals. A p-value of 0.05 determined significance.
Of 214,098 records, there were 27,956 eligible patients. Average age was 63.9 ± 11.2 years, 17,769 (63.6%) were male, and 10,182 (36.4%) patients were female. Most of the cohort was White (51.1%), Medicare payer (64.3%), and treated at a large-bed size (80.7%), private non-profit (76.9%), and metro-teaching (94.0%) hospital. Neuropsychiatric comorbidity prevalence ranged from 29.9% to 47.7% depending on indication. Compared with PD, odds of complications and unfavorable disposition were significantly higher with other movement disorders and dystonia, whereas OCD conferred greater risk for HEHCs (p < 0.05). Patients with ET had favorable outcomes. Neuropsychiatric comorbidity, Black race, and Charlson Comorbidity Index > 0 were significantly associated with unfavorable outcomes (p < 0.05).
The risk of adverse inpatient outcomes for DBS in the United States is independently correlated with non-PD/ET disorders, neuropsychiatric comorbidity, and non-White race, reflecting the heterogeneity and infancy of widespread DBS for these patients.
确定神经精神共病、调节指征、人口统计学特征和其他特征如何影响住院深部脑刺激（DBS）的结果。
这是一项回顾性研究，对全国住院患者样本（National Inpatient Sample）45 个月的数据进行分析。患者年龄≥18 岁，在美国医院接受 DBS 治疗帕金森病（PD）、原发性震颤（ET）、一般性肌张力障碍和相关疾病、其他运动障碍（非 PD/ET）或强迫症（OCD）。主要终点是延长住院时间（PLOS）、高额医院费用（HEHCs）、不良转归和住院并发症。使用 95%置信区间下的优势比构建逻辑模型。p 值<0.05 表示差异具有统计学意义。
在 214098 份记录中，有 27956 名符合条件的患者。平均年龄为 63.9±11.2 岁，17769 名（63.6%）为男性，10182 名（36.4%）为女性。队列中大多数为白人（51.1%）、医疗保险支付者（64.3%），在床位规模较大（80.7%）、非盈利私立（76.9%）、大都市教学（94.0%）医院接受治疗。神经精神共病的患病率根据指征不同在 29.9%至 47.7%之间。与 PD 相比，其他运动障碍和肌张力障碍患者发生并发症和不良转归的几率明显更高，而 OCD 则增加了 HEHCs 的风险（p<0.05）。ET 患者有良好的预后。神经精神共病、黑人种族和 Charlson 合并症指数>0 与不良结局显著相关（p<0.05）。
美国 DBS 住院不良结果的风险与非 PD/ET 疾病、神经精神共病和非白人种族独立相关，反映了这些患者 DBS 的异质性和不成熟性。
