Comparison of Deep Brain Stimulation and Responsive Neurostimulation Wound Complication Rates and Risk Factors: A...

Deep brain stimulation (DBS) and responsive neural stimulation (RNS) are effective for patients with pharmacoresistant epilepsy. Similar outcomes and increasingly convergent indications mean the choice of device may come down to other factors. Common to implanted therapeutic devices, wound-associated adverse outcomes are among the more common complications for these two procedures. However, there have been limited studies evaluating the differences in wound complication rates between DBS and RNS, despite the procedural differences for implantation for the two devices. Our objective was to analyze the differences in wound complication rates between patients who received DBS and RNS devices at the University of Colorado Hospital between 2016 and 2023.

All DBS and RNS surgeries performed from 2016 to 2023 for two surgeons at the University of Colorado Hospital were retrospectively reviewed. Wound complications included infection, hardware protrusion, or wound erosion requiring surgical washout, explant, or replacement. Risk factors evaluated included age, sex, diabetes, body mass index, and immunocompromised status. Incidence of complications and risk factors were evaluated and compared using a chi-squared and Mann-Whitney U test. The relationship between selected risk factors and the probability of wound complication was evaluated using a binomial logistic regression.

A total of 297 patients underwent DBS (n = 234, n = 218 for movement disorders, n = 16 for epilepsy) and RNS (n = 63) implantation. The DBS group had higher median age at the time of surgery compared to the RNS group (65 vs. 37, p < 0.001), and no other significant differences in group characteristics were noted. Wound complication incidence was greater in the RNS group compared to DBS (12.7% vs. 4.3%, p < 0.001). No other risk factors were noted to contribute to wound complication rate.

Wound complication incidence was greater in RNS patients compared to DBS patients. Differences in age, sex, body mass index, and immunocompromised status were not associated with increased wound complication risk.