Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2025
Deep brain stimulation within a multi-center US-based healthcare system - A descriptive epidemiologic review from 2010 through 2021.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Sedrak Mark F, Chang Richard N, Pezeshkian Patrick, Reyes Chelsea E, Prentice Heather A, Paxton Elizabeth W, Skordilis Monica A, Hickey Patrick T, Srivastava Siddharth, Anderson Ross
Аннотация
BACKGROUND: Given recent advancements in deep brain stimulation (DBS), practice variation and outcomes in large, community-based practices are important to understand. We sought to describe a well-defined cohort of patients who underwent DBS placement within a US-based integrated healthcare system on the West Coast and including Hawaii, over 12 years.
METHODS: Patients who underwent initial DBS placement were identified using Kaiser Permanente's electronic health record (2010-2021). Crude cumulative implantable pulse generator (IPG) replacement, reoperation, and mortality probabilities were calculated as 1 minus the Kaplan-Meier estimator. 90-day incidence of emergency department (ED) visits and readmissions was calculated as the number of patients with the event of interest over the number of patients at risk.
RESULTS: 1,158 patients had a complete DBS system placed by 12 surgeons across 7 facilities in the healthcare system. 769 patients received bilateral systems (674 with 2 leads and 1 IPG and 95 with 2 leads and 2 IPG), while 389 received unilateral systems. Following DBS placement, 14.3 %, 8.5 %, and 1.2 % had a 90-day ED visit, readmission, and infection, respectively. Median time to IPG replacement was 3.5 years. At 3-years follow-up, 14.5 % had an IPG replacement and 18.1 % had a reoperation; 5-year mortality was 9.3 %.
CONCLUSION: This study highlights the sum of practices over a decade in a large community-based healthcare system. In particular, original implantation techniques varied, and utilization of rechargeable systems increased over time. Given the incidence of readmissions, ED visits, and reoperations, future study is needed to understand modifiable risk factors to mitigate unwanted outcomes.
METHODS: Patients who underwent initial DBS placement were identified using Kaiser Permanente's electronic health record (2010-2021). Crude cumulative implantable pulse generator (IPG) replacement, reoperation, and mortality probabilities were calculated as 1 minus the Kaplan-Meier estimator. 90-day incidence of emergency department (ED) visits and readmissions was calculated as the number of patients with the event of interest over the number of patients at risk.
RESULTS: 1,158 patients had a complete DBS system placed by 12 surgeons across 7 facilities in the healthcare system. 769 patients received bilateral systems (674 with 2 leads and 1 IPG and 95 with 2 leads and 2 IPG), while 389 received unilateral systems. Following DBS placement, 14.3 %, 8.5 %, and 1.2 % had a 90-day ED visit, readmission, and infection, respectively. Median time to IPG replacement was 3.5 years. At 3-years follow-up, 14.5 % had an IPG replacement and 18.1 % had a reoperation; 5-year mortality was 9.3 %.
CONCLUSION: This study highlights the sum of practices over a decade in a large community-based healthcare system. In particular, original implantation techniques varied, and utilization of rechargeable systems increased over time. Given the incidence of readmissions, ED visits, and reoperations, future study is needed to understand modifiable risk factors to mitigate unwanted outcomes.