Deep brain stimulation within a multi-center US-based healthcare system - A descriptive epidemiologic review from...

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.

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.

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 %.

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.