Deep Brain Stimulation for Movement Disorders in Spain: Temporal Trends, Complications, and Sex-Related Disparities...

Background/Objectives: This study aimed to describe temporal trends in deep brain stimulation (DBS) use for Parkinson's disease (PD), essential tremor (ET), and dystonia; characterize patient age and sex distribution and comorbidity; assess postoperative complications and in-hospital mortality (IHM) after implantation and explantation; and explore sex-specific differences in utilization and outcomes. Methods: We conducted a retrospective nationwide population-based study using the Spanish National Hospital Discharge Database (RAE-CMBD) from 2002 to 2019. All hospital admissions with DBS implantation or explantation/revision and a diagnosis of PD, ET, or dystonia were identified. Sociodemographic variables, the Charlson Comorbidity Index (CCI), length of hospital stay (LOHS), postoperative complications, and IHM were analyzed across three calendar periods and stratified by diagnosis and sex. Results: A total of 4883 admissions for DBS electrode implantations and 497 admissions for DBS explantation/revision were recorded. PD accounted for 82.6% of implantations, followed by ET (11.2%) and dystonia (6.3%). DBS activity increased significantly over time, while median LOHS declined from 12 to 6 days for implantations and from 13 to 5 days for explantations. Overall IHM after implantation was 0.27%, decreasing to 0.05% in 2014-2019; IHM after explantation was 0.6%. Most hospitalizations had low comorbidity (CCI = 0 in 87.8%), although comorbidity increased over time. Men represented approximately 60% of procedures in PD and ET. Women with PD underwent DBS at older ages, despite similar LOHS and IHM. Postoperative complications were recorded in 14.6% of implantations, mainly hardware-related issues (5-6%) and infections (1-2%), whereas infections (33%) and mechanical problems (27%) predominated among explantations. Conclusions: DBS use in Spain has expanded substantially, with shorter hospital stays and very low in-hospital mortality. Sex-related differences in utilization are increasing, and hardware complications and infections remain the most frequent conditions associated with explantation. As complications were identified only during the same hospitalization as the DBS procedure, late post-discharge events are not captured and could be underestimated; patient-level risks cannot be derived.