TY - JOUR
T1 - Impact of advancing age on post-operative complications of deep brain stimulation surgery for essential tremor
AU - Verla, Terence
AU - Marky, Andrew
AU - Farber, Harrison
AU - Petraglia, Frank W.
AU - Gallis, John
AU - Lokhnygina, Yuliya
AU - Parente, Beth
AU - Hickey, Patrick
AU - Turner, Dennis A.
AU - Lad, Shivanand P.
N1 - Funding Information:
Shivanand Lad, MD, PhD, has consulted for or received grant support from Medtronic, Boston Scientific and St. Jude Medical. He serves as Director of the Duke Neuro-Outcomes Center which has received research funding from NIH KM1 CA 156687. The remaining authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
Funding Information:
The Duke CTSA team was supported by the USA National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001117. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2014 Elsevier Ltd. All rights reserved.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Essential tremor (ET) was the original indication for deep brain stimulation (DBS), with USA Food and Drug Administration approval since 1997. Despite the efficacy of DBS, it is associated with surgical complications that cause sub-optimal clinical outcomes. Given that ET is a progressive disease with increase in symptom severity with increasing age, this study evaluated the impact of increasing age on short-term complications following DBS surgery for ET. The Thomson-Reuters MarketScan database was utilized (New York, NY, USA). Patients selected were over age 18 and underwent DBS for ET between the years 2000 and 2009. Multivariable logistic regression analysis was used to calculate complication odds ratios (OR) for a 5 year increase in age, after controlling for other covariates. Six hundred sixty-one patients were included in the analysis. The mean (standard deviation) age was 61.9 (14.3) years, with 17% of individuals aged ≥75 years. Overall 56.9% of patients were male, and 44.6% had a Charlson Comorbidity Score of ≥1. Additionally, 7.1% of patients experienced at least one complication within 90 days, including wound infections (3.0%), pneumonia (2.4%), hemorrhage or hematoma (1.5%), or pulmonary embolism (0.6%). Increasing age was not significantly associated with the overall 90 day complication rates (OR 0.89; 95% confidence interval [CI] 0.77-1.02; p = 0.102). The risk of the two most common procedure-related complications, hemorrhage and infection, did not significantly increase with age (hemorrhage: OR 1.02; 95%CI 0.77-1.37; p = 0.873; and infection: OR 0.88; 95%CI 0.72-1.07; p = 0.203). Our findings suggest that age should not be a primary exclusion factor for determining candidacy for DBS and also suggest a possible expansion of the traditional therapeutic window since post-operative complications remained relatively stable.
AB - Essential tremor (ET) was the original indication for deep brain stimulation (DBS), with USA Food and Drug Administration approval since 1997. Despite the efficacy of DBS, it is associated with surgical complications that cause sub-optimal clinical outcomes. Given that ET is a progressive disease with increase in symptom severity with increasing age, this study evaluated the impact of increasing age on short-term complications following DBS surgery for ET. The Thomson-Reuters MarketScan database was utilized (New York, NY, USA). Patients selected were over age 18 and underwent DBS for ET between the years 2000 and 2009. Multivariable logistic regression analysis was used to calculate complication odds ratios (OR) for a 5 year increase in age, after controlling for other covariates. Six hundred sixty-one patients were included in the analysis. The mean (standard deviation) age was 61.9 (14.3) years, with 17% of individuals aged ≥75 years. Overall 56.9% of patients were male, and 44.6% had a Charlson Comorbidity Score of ≥1. Additionally, 7.1% of patients experienced at least one complication within 90 days, including wound infections (3.0%), pneumonia (2.4%), hemorrhage or hematoma (1.5%), or pulmonary embolism (0.6%). Increasing age was not significantly associated with the overall 90 day complication rates (OR 0.89; 95% confidence interval [CI] 0.77-1.02; p = 0.102). The risk of the two most common procedure-related complications, hemorrhage and infection, did not significantly increase with age (hemorrhage: OR 1.02; 95%CI 0.77-1.37; p = 0.873; and infection: OR 0.88; 95%CI 0.72-1.07; p = 0.203). Our findings suggest that age should not be a primary exclusion factor for determining candidacy for DBS and also suggest a possible expansion of the traditional therapeutic window since post-operative complications remained relatively stable.
KW - Age
KW - Complications
KW - Deep brain stimulation
KW - Essential tremor
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U2 - 10.1016/j.jocn.2014.11.005
DO - 10.1016/j.jocn.2014.11.005
M3 - Article
C2 - 25669119
AN - SCOPUS:84927177690
VL - 22
SP - 872
EP - 876
JO - Journal of Clinical Neuroscience
JF - Journal of Clinical Neuroscience
SN - 0967-5868
IS - 5
ER -