Management of a Multidisciplinary Surgical Obsessive-Compulsive Disorder Practice

Assessing patients with obsessive-compulsive disorder (OCD) for surgery is challenging due to their complex psychiatric histories, extensive and often fragmented treatment records, wide geographic spread, and lack of awareness among patients and providers about surgical options. We analyze the presurgical evaluation pipeline of our practice to identify crucial aspects of an efficient multidisciplinary surgical OCD service.

We conducted a cross-sectional study of all patients evaluated for surgical treatment of OCD by our clinic from January 2018 to December 2023. We retrospectively reviewed internal clinic records to track each patient's progress through our presurgical evaluation pipeline, from initial contact to surgical treatment, and identified the primary causes of attrition. In addition, we analyzed the insurance approval history and geographic spread of patients who underwent surgical treatment to assess the impact of these factors as potential barriers to surgical care.

From 2018 to 2023, we evaluated 102 patients (81% self-referred; 19% provider-referred). Of these 102 patients, we evaluated 65 at virtual visits, 41 at on-site visits, and ultimately treated 31 patients with surgery (23, deep brain stimulation [DBS]; 8, laser interstitial thermal therapy [LITT] capsulotomy). Forty-three percent of patients offered surgery were initially denied insurance coverage, which did not differ by type of surgery received (DBS vs LITT; P = .67). Patients traveled a mean distance (±SD) of 730 ± 540 miles to our clinic for surgical care and follow-up, a distance significantly greater for LITT patients (1100 ± 540 miles) than that for DBS patients (590 ± 470 miles, P = .012).

Screening mechanisms are essential for efficiently evaluating patients with OCD for surgical management. We also found low provider referral rates, high insurance denial rates, and long travel distances to be principal barriers patients with OCD face in accessing surgical therapy.