Changing practice patterns of deep brain stimulation in Parkinson's disease and essential tremor in the USA
Department of Surgery
Medical Subject Headings
Adult; Aged; Aged, 80 and over; Comorbidity; *Deep Brain Stimulation; Essential Tremor; Female; Humans; Inpatients; Male; Middle Aged; Parkinson Disease; Physician's Practice Patterns; Retrospective Studies; Treatment Outcome; United States
Health Services Research | Nervous System Diseases | Surgery
BACKGROUND: Randomized controlled studies have shown deep brain stimulation (DBS) to be an effective treatment for Parkinson's disease (PD). Outside of large-center studies, little is known about trends in DBS use in the USA.
OBJECTIVES: We employ the Nationwide Inpatient Sample to look at changes in DBS utilization over time.
METHODS: We identified all individuals with PD (332.0) and essential tremor (ET) (333.1) who underwent DBS (02.93) from 1998 to 2007. We examined demographics, hospital status, comorbidities, and in-hospital systemic/technical complications. DBS patients from 2000 and 2007 were compared using chi(2) tests.
RESULTS: PD patients from the 2007 sample who underwent DBS were older (p = 0.01). Both ET and PD patients had significantly more comorbidities in 2007 (p < 0.001). In-hospital complications decreased from 3.8 to 2.8%. DBS was performed in medium- or high-volume centers in 70% of cases in 2000 and in 50% in 2007. In all groups, a majority of cases (range 65-71%) underwent DBS at hospitals in the western and southern USA.
CONCLUSIONS: Patients who underwent DBS in the 2007 sample were older and had more comorbidities than those in the 2000 sample; in-hospital complications remained low. Understanding trends in DBS is helpful in assessing how the technology is adopted and what relationships should be further explored.