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Published on: March 23, 2019
Impact of Hospital Volume Status on Postoperative Outcomes and Cost following Deep Brain Stimulation for Movement
Stefan T Prvulovic1,2, Omar Sbaih3,4, Michael M Covell3,4
1School of Medicine, Georgetown University, Washington, DC, USA, sp1308@georgetown.edu.
Introduction:
Deep brain stimulation (DBS) has emerged as a transformative neurosurgical intervention for refractory movement disorders, including Parkinson's disease (PD), essential tremor (ET), and dystonia. While clinical efficacy is well established, significant variability exists in procedural outcomes across hospitals. This nationwide study investigated the impact of hospital procedural volume on short-term postoperative outcomes and cost following DBS across 234 US hospitals from 2015 to 2020.
Methods:
We conducted a retrospective analysis of 6,964 DBS procedures (2015-2020) using the Nationwide Inpatient Sample. Hospitals were categorized by 6-year DBS volume: high-volume centers (HVCs, ≥450), medium-volume (50-449), and low-volume (<50). Multivariable regression assessed outcomes, including prolonged length of stay (pLOS >75th percentile), nonroutine discharge (NRD), high charge (>90th percentile), and complications, controlling for patient demographics, comorbidities, and hospital characteristics.
Results:
HVCs showed superior outcomes compared with low-volume centers, with lower rates of pLOS (4.1% vs. 8.9%, p < 0.001), high charges (6.7% vs. 15.3%, p < 0.001), and NRD (11.0% vs. 16.5%, p < 0.001). PD patients had 45% greater odds of pLOS (OR = 1.45, 95% CI: 1.12-1.88, p = 0.004) but 36% lower odds of NRD (OR = 0.64, 95% CI: 0.49-0.83, p = 0.001) compared with ET patients. Dystonia patients had 2.4 times higher odds of pLOS (OR = 2.39, 95% CI: 1.76-3.25, p < 0.001) and 65% higher odds of incurring high charges (OR = 1.65, 95% CI: 1.22-2.23, p = 0.001). In multivariate models, HVCs were significantly associated with reduced risk of NRD, high charge, and pLOS.
Conclusion:
Despite a 6% decline in DBS volume due to fewer PD cases, inflation-adjusted charges rose >30% across centers. The volume-outcome relationship persists, with HVCs showing better efficiency but challenges in discharge disposition, highlighting the need for standardized care pathways for dystonia and closer evaluation of socioeconomic barriers to DBS access and outcomes.
